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Aboalata M, Plath J, Eltair H, Vogt S, Imhoff AB. Long-term results of arthroscopic capsulolabral revision repair for failed anterior shoulder instability repair using suture anchors at a minimum of 10 years follow-up. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05304-7. [PMID: 38693287 DOI: 10.1007/s00402-024-05304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Arthroscopic revision anterior shoulder instability repair has been proposed, and early clinical results have been promising. However, long-term results after this procedure and the probable risk factors for failure have not been sufficiently discussed in the literature. MATERIALS AND METHODS Thirty-eight patients who were diagnosed with recurrent anteroinferior shoulder instability after failed Bankart repair, treated with ACRR between September 1998 and November 2003 and able to be contacted were included. Of these patients, 2 were excluded from the study due to the use of SureTak anchors for fixation, and 5 other patients refused to participate in the study due to lack of interest (3 patients) or lack of time (2 patients). The remaining shoulders were clinically examined at a minimum of ten years after surgery via the ASES, Constant, AAOS, Rowe, Dawson and VAS scores for pain and stability. Degenerative arthropathy was assessed with the modified Samilson-Prieto score. RESULTS All 31 remaining shoulders were evaluated at a mean time of 11.86 years (142.4 months) after surgery. Six patients (19.35%) reported redisolcation after the revision procedure, 4 of whom were affected by a new significant shoulder trauma. The ROWE and Constant scores improved significantly. Moderate to severe dislocation arthropathy was observed in 19.4% of patients. Five patients (16.2%) were not satisfied with the procedure. CONCLUSION Long-term follow-up after ACRR shows predictable results, with a high degree of patient satisfaction, good to excellent patient-reported outcome scores and minimal radiological degenerative changes. However, with an average recurrence rate of 19.3% after 11.86 years, the redislocation rate appears high. With careful patient selection, recurrence rates can be significantly reduced.
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Affiliation(s)
- Mohamed Aboalata
- Department of orthopaedic Surgery, Mansoura University, Mansoura, Egypt.
- Department of Orthopaedic Surgery, Rhön klinik Campus Bad Neustadt, Bad Neustadt an der Saale, Germany.
| | - Johannes Plath
- Department of Trauma Surgery, Hand and Plastic Surgery, University of Augsburg, Augsburg, Germany
| | - Hani Eltair
- Department of Orthhopedic surgery, Students' hospital Mansoura University, Mansoura, Egypt
- Department of Orthopedic surgery, Bad Windsheim hospital, Bad Windsheim, Germany
| | - Stephan Vogt
- Department of sport orthopaedic, Hessing clinic, Augsburg, Germany
| | - Andreas B Imhoff
- Department of orthopaedic sports medicine, Klinikum Rechts der Isar, TUM, Munich, Germany
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Reuter S, Lambert C, Schadt M, Imhoff AB, Centner C, Herbst E, Stöcker F, Forkel P. Effects of transcranial direct current stimulation and sensorimotor training in anterior cruciate ligament patients: a sham-controlled pilot study. Sportverletz Sportschaden 2024. [PMID: 38657648 DOI: 10.1055/a-2285-7159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Studies showed changes in the central nervous system in patients who sustained an anterior cruciate ligament tear. There is a lack of evidence regarding the effectiveness of transcranial direct-current stimulation in such patients. METHODS A sham-controlled randomised study. One group of patients (n = 6) underwent 6 weeks of sensorimotor training after an anterior cruciate ligament tear during transcranial direct-current stimulation. The stimulation consisted of 20 minutes (3 sessions/week; 2 weeks) of 2 mA anodal transcranial direct-current stimulation over the primary motor and premotor cortex. The second group (n = 6) received sham stimulation with 6 weeks of sensorimotor training. Centre of pressure deviations in the medio-lateral and anterior-posterior direction and centre of pressure velocity were measured. RESULTS The results demonstrated a significant effect of sensorimotor training on the centre of pressure in medio-lateral and anterior-posterior direction (p=0.025) (p=0.03) in the leg in which an anterior cruciate ligament tear occurred. The type of training did not affect the results. Post-hoc tests showed no significant effect of training in the subgroups (p≥0.115). CONCLUSION Sensorimotor training led to a decrease in sway of the centre of pressure in patients who sustained an anterior cruciate ligament tear, but the addition of anodal transcranial direct-current stimulation placed over the primary motor cortex did not potentiate the adaptive responses of the sensorimotor training.
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Affiliation(s)
- Sven Reuter
- SRH University of Applied Sciences Heidelberg: SRH Hochschule Heidelberg, Gera, GERMANY
| | - Christophe Lambert
- Deparment of Trauma and Orthopedic Surgery, University of Witten/Herdecke: Universitat Witten/Herdecke, Cologne, GERMANY
| | - Maja Schadt
- Department of Biomechanics in Sports, Technical University Munich: Technische Universitat Munchen, München, GERMANY
| | - Andreas B Imhoff
- Department for Orthopaedic Sports Medicine, Munich University of Technology: Technische Universitat Munchen, München, GERMANY
| | - Christoph Centner
- University of Freiburg im Breisgau: Albert-Ludwigs-Universitat Freiburg, Freiburg, GERMANY
| | - Elmar Herbst
- Department for Orthopaedic Sports Medicine, Technische Universität München: Technische Universitat Munchen, München, GERMANY
| | - Fabian Stöcker
- Department of Biomechanics in Sports, Technische Universität München: Technische Universitat Munchen, München, GERMANY
| | - Philipp Forkel
- Department for Orthopaedic Sports Medicine, Technische Universität München: Technische Universitat Munchen, München, GERMANY
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Rupp MC, Hochberger F, Berthold DP, Muench LN, Imhoff AB, Siebenlist S, Willinger L. Tibiofemoral Subluxation on Radiograph as a Predictor of Location and Size of Osteochondritis Dissecans Lesions of the Knee. Orthop J Sports Med 2024; 12:23259671241232397. [PMID: 38455152 PMCID: PMC10919139 DOI: 10.1177/23259671241232397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 03/09/2024] Open
Abstract
Background Lower limb malalignment has been associated with osteochondritis dissecans (OCD). However, the location of the OCD lesion often is not concordant with the mechanical leg axis. Other potentially modifiable alignment parameters may influence the propensity for impingement of the femoral condyles. Purpose To assess differences in lower limb alignment (LLA) and relative tibiofemoral position between patients with medial (MFC-OCD) or lateral OCD (LFC-OCD) of the femoral condyle. Study Design Cohort study; Level of evidence, 3. Methods Patients ≤30 years old who were diagnosed with unicondylar OCD between January 2010 and January 2020 were eligible for this study. Included were 55 patients (age, 20.8 ± 4.5 years)-46 with MFC-OCD and 9 with LFC-OCD. Preoperative standing long-leg radiographs were studied to obtain primary outcomes-including LLA and mechanical alignment analyses-and secondary outcomes-including knee joint obliquity angle; rotation angle; medial, central (c-subluxation), and lateral subluxation (L-subluxation) of the tibia relative to the femur in the coronal plane; and tibiofemoral joint line center distance (TFJCD). Results With regard to primary outcomes, LLA was significantly different between MFC-OCD (1.7°± 3.1° varus) and LFC-OCD (2.7 ± 3.1° valgus) (P < .001), and 78% (36/46) of patients with MFC-OCD had varus alignment, whereas 78% (7/9) of patients with LFC-OCD had valgus alignment (P < 0.002). With regard to secondary outcomes, patients with MFC-OCD had a more medial tibial position in relation to the femur, with a significantly smaller rotation angle (5.6°± 2.4° vs 9.6°± 3.6°; P < .001), a smaller C-subluxation (7.2 ± 6.6 vs 14.9 ± 8.8 mm; P < .01), a smaller L-subluxation (2.3 ± 2.6 vs 4.4 ± 2.7 mm; P < .05), and reduced TFJCD (3.5 ± 1.7 vs 6.6 ± 1.8 mm; P < .001) compared with the LFC-OCD group. For patients with MFC-OCD, the size of the OCD was significantly correlated with C-subluxation (r = 0.412; P = .006). Conclusion LLA was significantly different according to OCD location. In patients with MFC-OCD, the tibia was subluxated medially, resulting in a change of joint geometry by approximation of the medial tibial eminence toward the medial femoral condyle, potentially causing excessive pressure overload and microtrauma of the cartilage. Interestingly, the extent of subluxation was correlated with OCD size.
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Affiliation(s)
| | - Felix Hochberger
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | - Daniel P. Berthold
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich (LMU Munich), Munich, Germany
| | - Lukas N. Muench
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
| | | | - Lukas Willinger
- Department of Sports Orthopaedics, Technical University Munich, Munich, Germany
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Berthold DP, Muench LN, Kadantsev P, Siebenlist S, Scheiderer B, Mazzocca AD, Calvo E, Imhoff AB, Beitzel K, Hinz M. The importance of a structured failure analysis in revision acromioclavicular joint surgery: A multi-rater agreement on the causes of stabilization failure from the ISAKOS shoulder committee. J ISAKOS 2023; 8:425-429. [PMID: 37562575 DOI: 10.1016/j.jisako.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Acromioclavicular joint (ACJ) stabilizations are associated with a high overall failure rate with 9.5% of these patients requiring subsequent revision surgery. Consequently, understanding the specific cause of primary ACJ stabilization failure is paramount to improving surgical decision-making in this challenging patient cohort. PURPOSE To (1) identify risk factors and mechanisms for failure following primary arthroscopically-assisted ACJ stabilization to highlight the importance of conducting a detailed failure analysis and to (2) establish revision strategies based on real-life cases of primary failed ACJ stabilization. STUDY DESIGN Level of evidence IV. METHODS A survey was shared internationally among members of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) shoulder committee. The survey contained failure analysis of 11 real-life cases of failed primary arthroscopically-assisted ACJ stabilization. For each case, a thorough patient history, standardized radiographs, and CT scans were provided. Participants were asked to give their opinion on bone tunnel placement, cause of failure (biological, technical, traumatic, or combined), the stabilization technique used, as well as give a recommendation for revision. RESULTS Seventeen members of the ISAKOS shoulder committee completed the survey. Biological failure was considered the most common cause of failure (47.1%), followed by technical (35.3%) and traumatic (17.6%) failure. The majority deemed two modifiable factors (i.e., patient's profession and sport) as well as non-modifiable factors (i.e., patient's age and time from trauma to initial surgery) to be risk factors for failure. In 10 of 11 cases, the correct fixation device was used in the primary setting (90.9%; 52.8-82.4% agreement); however, in eight of those cases, the technique was not performed correctly (80.0%; 58.8-100% agreement). In 8 of all 11 cases, the majority recommended an arthroscopically assisted technique with graft augmentation for revision (52.9-58.8% agreement). CONCLUSION Biological failure and technical failure are the most common reason for failure in primary ACJ stabilization followed by traumatic failure. Besides, biological failure can be triggered by technical errors such as clavicular or coracoidal tunnel misplacement. Consequently, a detailed failure analysis including preoperative CT should be conducted on the causes of primary ACJ failure, and, if possible, an arthroscopically-assisted technique with graft augmentation should be prioritized in revision ACJ surgery. CLINICAL RELEVANCE ACJ stabilizations are associated with a high overall failure rate - potentially due to biological and technical properties. When encountering failed arthroscopically-assisted ACJ stabilization, a detailed failure analysis should be conducted on the causes of primary ACJ failure. Furthermore, an arthroscopically-assisted revision stabilization is feasible in most cases.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, 80336 Munich, Germany; Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany.
| | - Lukas N Muench
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany
| | - Pavel Kadantsev
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany
| | - Bastian Scheiderer
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany
| | - Augustus D Mazzocca
- Massachusetts General Hospital, Massachusetts General Brigham, Harvard Medical School, Boston, MA 02115, USA
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany
| | - Knut Beitzel
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany; Department of Shoulder Surgery, ATOS Clinic, 50858 Cologne, Germany
| | - Maximilian Hinz
- Department of Sports Orthopaedics, Technical University of Munich, 81677 Munich, Germany
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Hinz M, Geyer S, Winden F, Braunsperger A, Kreuzpointner F, Irger M, Imhoff AB, Mehl J. Clinical and biomechanical outcomes following patellar tendon repair with suture tape augmentation. Eur J Orthop Surg Traumatol 2023; 33:3569-3576. [PMID: 37233797 PMCID: PMC10651537 DOI: 10.1007/s00590-023-03572-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Patellar tendon ruptures (PTR) occur predominantly in middle-aged patients following indirect trauma. The aim of this study was to quantify the short-term results using a suture tape augmentation technique for the repair of PTR. METHODS All consecutive patients with acute (< 6 weeks) PTR who underwent suture tape augmentation between 03/2014 and 11/2019 at a single institution with a minimum follow-up of 12 months were retrospectively evaluated. Outcome measures included Visual Analog Scale (VAS) for pain, Tegner Activity Scale (TAS) and return to sport rates, Lysholm score, International Knee Documentation Committee subjective knee form (IKDC) as well as Knee Injury and Osteoarthritis Outcome Score (KOOS). Additionally, a standardized clinical examination and an isometric strength evaluation of knee extension and flexion were performed. It was hypothesized that high return to sport rates and good functional outcome would be observed and that the majority of patients would not present with a severe (> 20%) knee extension strength deficit when compared to the contralateral side. RESULTS A total of 7 patients (mean age 37.0 ± SD 13.5 years; 6 male/1 female) were available for final assessment at a median follow-up of 17.0 (25-75% IQR 16.0-77.0) months. Three injuries occurred during ball sports, two injuries occurred during winter sports, and one injury each occurred during a motorcycling and skateboarding accident. The average time between trauma and surgery was 4.7 ± 2.6 days. At follow-up, patients reported little pain (VAS: 0 [0-0.4]). Return to sport was possible for all patients 8.9 ± 4.0 months postoperatively at a high level (TAS: 7.0 [6.0-7.0]). Five patients (71.4%) returned to the preinjury level of play, and 2 (28.6%) did not return to the preinjury level of play. Patient-reported outcome measures were moderate to good (Lysholm score: 80.4 ± 14.5; IKDC: 84.2 ± 10.6; KOOS subscales: pain 95.6 ± 6.0, symptoms 81.1 [64.9-89.1], activities of daily living 98.5 [94.1-100], sport and recreation function 82.9 ± 14.1 and knee-related quality of life 75.9 ± 16.3). All patients were very satisfied (57.1%) or satisfied (42.9%) with the postoperative result. No postoperative complications were reported. Strength measurements revealed a severe knee extension deficit in 3 patients (42.9%), but no significant deficit of isometric knee extension or flexion strength in comparison with the contralateral side was observed overall (p > 0.05). CONCLUSION Suture tape augmentation in acute PTR repair leads to good functional outcome without major complications. Although a severe knee extension strength deficit may occur in some patients postoperatively, an excellent return to sports rate and high patient satisfaction can be expected nonetheless. LEVEL OF EVIDENCE Retrospective cohort study; III.
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Affiliation(s)
- Maximilian Hinz
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Stephanie Geyer
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Felix Winden
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexander Braunsperger
- Department of Sport and Health Sciences, Prevention Center, Technical University of Munich, Munich, Germany
| | - Florian Kreuzpointner
- Department of Sport and Health Sciences, Prevention Center, Technical University of Munich, Munich, Germany
| | - Markus Irger
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Julian Mehl
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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Rupp MC, Khan ZA, Dasari SP, Berthold DP, Siebenlist S, Imhoff AB, Chahla J, Pogorzelski J. Establishing the Minimal Clinically Important Difference and Patient Acceptable Symptomatic State following Patellofemoral Inlay Arthroplasty for Visual Analog Scale Pain, Western Ontario and McMaster Universities Arthritis Index, and Lysholm Scores. J Arthroplasty 2023; 38:2580-2586. [PMID: 37286052 DOI: 10.1016/j.arth.2023.05.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The purposes of the study were to define the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) after patello-femoral inlay arthroplasty (PFA) and to identify factors predictive for the achievement of clinically important outcomes (CIOs). METHODS A total of 99 patients who underwent PFA between 2009 and 2019 and had a minimum of 2-year postoperative follow-up were enrolled in this retrospective monocentric study. Included patients had a mean age of 44 years (range, 21 to 79). The MCID and PASS were calculated using an anchor-based approach for the visual analog scale (VAS) pain, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Lysholm patient-reported outcome measures. Factors associated with CIO achievement were determined using multivariable logistic regression analyses. RESULTS The established MCID thresholds for clinical improvement were -2.46 for the VAS pain score, -8.5 for the WOMAC score, and + 25.4 for the Lysholm score. Postoperative scores corresponding to the PASS were <2.55 for the VAS pain score, <14.6 for the WOMAC score, and >52.5 points for the Lysholm score. Preoperative patellar instability and concomitant medial patello-femoral ligament reconstruction were independent positive predictors of reaching both MCID and PASS. Additionally, inferior baseline scores and age were predictive of achieving MCID, whereas superior baseline scores and body mass index were predictive of achieving PASS. CONCLUSION This study determined the thresholds of MCID and PASS for the VAS pain, WOMAC, and Lysholm scores following PFA implantation at 2-year follow-up. The study demonstrated a predictive role of patient age, body mass index, preoperative patient-reported outcome measure scores, preoperative patellar instability, and concomitant medial patello-femoral ligament reconstruction in the achievement of CIOs. LEVEL OF EVIDENCE Prognostic Level IV.
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Affiliation(s)
- Marco-Christopher Rupp
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Zeeshan A Khan
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Suhas P Dasari
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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B Imhoff F, Imhoff AB. [Preoperative planning on 3D model]. Oper Orthop Traumatol 2023; 35:223-224. [PMID: 37747496 DOI: 10.1007/s00064-023-00823-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Florian B Imhoff
- Orthopädie und Sportorthopädie, Rennbahnklinik, Muttenz, Schweiz.
- Orthopädie und Traumatologie, Universitätsspital Basel, Basel, Schweiz.
| | - Andreas B Imhoff
- Sektion Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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Becher C, Megaloikonomos PD, Lind M, Eriksson K, Brittberg M, Beckmann J, Verdonk P, Högström M, Konradsen L, Holz J, Franz A, Feucht MJ, Kösters C, van Buul G, Sköldenberg O, Emans PJ, Boutefnouchet T, Nathwani D, McNicholas MJ, O'Donnell T, Spalding T, Stålman A, Ostermeier S, Imhoff AB, Shearman AD, Hirschmann M. High degree of consensus amongst an expert panel regarding focal resurfacing of chondral and osteochondral lesions of the femur with mini-implants. Knee Surg Sports Traumatol Arthrosc 2023; 31:4027-4034. [PMID: 37173573 DOI: 10.1007/s00167-023-07450-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION The rationale for the use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions is still under debate. The evidence supporting best practise guidelines is based on studies with low-level evidence. A consensus group of experts was convened to collaboratively advance towards consensus opinions regarding the best available evidence. The purpose of this article is to report the resulting consensus statements. METHODS Twenty-five experts participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted via an online survey of two rounds, for initial agreement and comments on the proposed statements. An in-person meeting between the panellists was organised during the 2022 ESSKA congress to further discuss and debate each of the statements. A final agreement was made via a final online survey a few days later. The strength of consensus was characterised as: consensus, 51-74% agreement; strong consensus, 75-99% agreement; unanimous, 100% agreement. RESULTS Statements were developed in the fields of patient assessment and indications, surgical considerations and postoperative care. Between the 25 statements that were discussed by this working group, 18 achieved unanimous, whilst 7 strong consensus. CONCLUSION The consensus statements, derived from experts in the field, represent guidelines to assist clinicians in decision-making for the appropriate use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Christoph Becher
- International Centre for Orthopedics, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany.
| | | | - Martin Lind
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Karl Eriksson
- Department of Orthopaedic Surgery, Stockholm South Hospital, Department of Clinical Science and Education Karolinska Institutet, Stockholm, Sweden
| | - Mats Brittberg
- Cartilage Research Unit, Region Halland Orthopaedics, Varberg Hospital, University of Gothenburg, Varberg, Sweden
| | - Johannes Beckmann
- Department of Orthopaedics and Traumatology, Barmherzige Brüder Hospital, Munich, Germany
| | | | - Magnus Högström
- Department of Surgical and Perioperative Sciences, Sports Medicine Umeå and Orthopedics, Umeå University, Umeå, Sweden
| | - Lars Konradsen
- Department of Orthopedic Surgery, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Alois Franz
- Hospital for Orthopedic Surgery and Sports Medicine, Siegen, Germany
| | - Matthias J Feucht
- Orthopaedic Clinic Paulinenhilfe, Diakonie-Hospital, Stuttgart, Germany
| | - Clemens Kösters
- Department of Traumatology and Orthopedics, Maria-Josef-Hospital Greven, Greven, Germany
| | - Gerben van Buul
- Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institute, Stockholm, Sweden
| | - Pieter J Emans
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tarek Boutefnouchet
- University Hospitals Birmingham NHS Trust, Mindelsohn Way, Edgbaston, Birmingham, UK
| | | | | | | | - Tim Spalding
- Cleveland Clinic London, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Anders Stålman
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | | | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Alexander D Shearman
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Michael Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
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Lacheta L, Siebenlist S, Scheiderer B, Beitzel K, Woertler K, Imhoff AB, Buchmann S, Willinger L. Intact revision rotator cuff repair stabilizes muscle atrophy and fatty infiltration after minimum follow up of two years. BMC Musculoskelet Disord 2023; 24:515. [PMID: 37353825 DOI: 10.1186/s12891-023-06616-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The extent of fatty infiltration and rotator cuff (RC) atrophy is crucial for the clinical results after rotator cuff repair (RCR). The purpose of this study was to evaluate changes in fatty infiltration and RC atrophy after revision RCR and to correlate them with functional outcome parameters. METHODS Patients who underwent arthroscopic revision RCR for symptomatic recurrent full-thickness tear of the supraspinatus tendon between 2008 and 2014 and were retrospectively reviewed with a minimum follow up of 2 years. Magnetic resonance imaging (MRI) was performed pre- and postoperatively to assess 1) tendon integrity after revision RCR according to Sugaya classification, (2) RC atrophy according to Thomazeau classification, and (3) fatty infiltration according to Fuchs MRI classification. Constant score (CS) and the American Shoulder and Elbow Surgeon (ASES) score were used to correlate functional outcome, tendon integrity, and muscle degeneration. RESULTS 19 patients (17 males and 2 females) with a mean age of 57.5 years (range, 34 to 72) were included into the study at a mean follow-up of 50.3 months (range, 24 - 101). At final evaluation, 9 patients (47%) presented with intact RCR and 10 patients (53%) suffered a re-tear after revision repair. No progress of fatty infiltration was observed postoperatively in the group with intact RC, atrophy progressed in only 1 out of 9 patient (11%). Fatty infiltration progressed in 5/10 patients (50%) and RC atrophy increased in 2/10 patients (20%) within the re-tear group. CS (42.7 ± 17.7 preop, 65.2 ± 20.1 postop) and ASES (47.7 ± 17.2 preop, 75.4 ± 23.7 postop) improved significantly from pre- to postoperatively (p < 0.001). A positive correlation between fatty infiltration and RC integrity was detected (r = 0.77, p < 0.01). No correlation between clinical outcome and tendon integrity or RC atrophy was observed. CONCLUSION Arthroscopic revision RCR leads to reliable functional outcomes even in case of a recurrent RC retear. An intact RCR maintains the preoperative state of fatty infiltration and muscle atrophy but does not lead to muscle regeneration. LEVEL OF EVIDENCE Level IV; Therapeutic study.
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Affiliation(s)
- Lucca Lacheta
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- ATOS Orthoparc Klinik, Cologne, Germany
| | - Klaus Woertler
- Musculoskeletal Radiology Section, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stefan Buchmann
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Orthopaedisches Fachzentrum (OFZ) Weilheim/Garmisch/Starnberg/Penzberg, Weilheim, Germany
| | - Lukas Willinger
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Otto A, Muench LN, Mehl J, Baldino JB, Murphy M, Obopilwe E, Cote MP, Scheiderer B, Imhoff AB, Mazzocca AD, Siebenlist S. Dual Bracing for Ulnar Collateral Ligament Injuries Restores Native Valgus Laxity and Native Medial Joint Gapping of the Elbow. Orthop J Sports Med 2023; 11:23259671231179179. [PMID: 37378277 PMCID: PMC10291402 DOI: 10.1177/23259671231179179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 02/26/2023] [Indexed: 06/29/2023] Open
Abstract
Background Despite growing evidence on the role of the posterior ulnar collateral ligament (pUCL) in elbow stability, current ligament bracing techniques are mainly focused on the anterior ulnar collateral ligament (aUCL). A dual-bracing technique combines the repair of the pUCL and aUCL with a suture augmentation of both bundles. Purpose To biomechanically assess a dual-bracing approach addressing aUCL and pUCL for humeral-sided complete UCL lesions to restore medial elbow laxity without overconstraining. Study Design Controlled laboratory study. Methods A total of 21 unpaired human elbows (11 right, 10 left; 57.19 ± 11.7 years) were randomized into 3 groups to compare dual bracing with aUCL suture augmentation and aUCL graft reconstruction. Laxity testing was performed with 25 N applied 12 cm distal to the elbow joint for 30 seconds at randomized flexion angles (0°, 30°, 60°, 90°, and 120°) for the native condition and then for each surgical technique. A calibrated motion capture system was used for assessment, allowing the 3-dimensional displacement during the complete valgus stress cycle between the optical trackers to be quantified as joint gap and laxity. The repaired constructs were then cyclically tested through a materials testing machine starting with 20 N for 200 cycles at a rate of 0.5 Hz. The load was increased stepwise by 10 N for 200 cycles until displacement reached 5.0 mm or complete failure occurred. Results Dual bracing and aUCL bracing resulted in significantly (P = .045) less joint gapping at 120° of flexion compared with aUCL reconstruction. No significant differences in valgus laxity were found among the surgical techniques. Within each technique, there were no significant differences between the native and the postoperative state in valgus laxity and joint gapping. No significant differences between the techniques were observed in cycles to failure and failure load. Conclusion Dual bracing restored native valgus joint laxity and medial joint gapping without overconstraining and provided similar primary stability regarding failure outcomes as established techniques. Furthermore, it was able to restore joint gapping in 120° of flexion significantly better than aUCL reconstruction. Clinical Relevance This study provides biomechanical data on the dual-bracing approach that may help surgeons to consider this new method of addressing acute humeral UCL lesions.
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Affiliation(s)
- Alexander Otto
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Lukas N. Muench
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Julian Mehl
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Joshua B. Baldino
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, USA
| | - Matthew Murphy
- Beaumont Orthopedic Institute Royal Oak, Royal Oak, Michigan, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, USA
| | - Mark P. Cote
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Bastian Scheiderer
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sebastian Siebenlist
- Department of Sports Orthopedics, Technical University of Munich, Munich, Germany
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Petersen W, Guenther D, Imhoff AB, Herbort M, Stein T, Schoepp C, Akoto R, Höher J, Scheffler S, Stoehr A, Stoffels T, Häner M, Hees T, Mehl J, Ellermann A, Krause M, Mengis N, Eberle C, Müller PE, Best R, Lutz PM, Achtnich A. Management after acute rupture of the anterior cruciate ligament (ACL). Part 1: ACL reconstruction has a protective effect on secondary meniscus and cartilage lesions. Knee Surg Sports Traumatol Arthrosc 2023; 31:1665-1674. [PMID: 35445329 PMCID: PMC10089999 DOI: 10.1007/s00167-022-06960-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this consensus project was to validate which endogenous and exogenous factors contribute to the development of post-traumatic osteoarthritis and to what extent ACL (anterior cruciate ligament) reconstruction can prevent secondary damage to the knee joint. Based on these findings, an algorithm for the management after ACL rupture should be established. METHODS The consensus project was initiated by the Ligament Injuries Committee of the German Knee Society (Deutsche Kniegesellschaft, DKG). A modified Delphi process was used to answer scientific questions. This process was based on key topic complexes previously formed during an initial face-to-face meeting of the steering group with the expert group. For each key topic, a comprehensive review of available literature was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Consensus was defined a-priori as eighty percent agreement. RESULTS Of the 17 final statements, 15 achieved consensus, and 2 have not reached consensus. Results of the consensus were summarized in an algorithm for the management after ACL rupture (infographic/Fig. 2). CONCLUSION This consensus process has shown that the development of post-traumatic osteoarthritis is a complex multifactorial process. Exogenous (primary and secondary meniscus lesions) and endogenous factors (varus deformity) play a decisive role. Due to the complex interplay of these factors, an ACL reconstruction cannot always halt post-traumatic osteoarthritis of the knee. However, there is evidence that ACL reconstruction can prevent secondary joint damage such as meniscus lesions and that the success of meniscus repair is higher with simultaneous ACL reconstruction. Therefore, we recommend ACL reconstruction in case of a combined injury of the ACL and a meniscus lesion which is suitable for repair. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Wolf Petersen
- Sportsclinic Berlin, Department of Orthopedics, Martin Luther Hospital, Berlin-Grunewald, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany
| | - Daniel Guenther
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine Cologne Merheim Medical Center (Witten/Herdecke University), Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Mirco Herbort
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | - Thomas Stein
- SPORTHOLOGICUM® Frankfurt Am Main, Siesmayerstraße 44, 60323, Frankfurt am Main, Germany
- Department of Sports Medicine, Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt am Main, Germany
| | - Christian Schoepp
- Department of Arthroscopic Surgery, Sports Traumatology and Sports Medicine, BG Klinikum, Duisburg gGmbH, Großenbaumer Allee 250, 47249, Duisburg, Germany
| | - Ralph Akoto
- Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Jürgen Höher
- SPORTSCLINIC COLOGNE, Ostmerheimer Str. 200, 51109, Köln, Germany
| | - Sven Scheffler
- Sporthopaedicum Berlin, Bismarckstrasse 45-47, 10627, Berlin, Germany
| | - Amelie Stoehr
- OCM Clinic Munich, Steinerstrasse 6, 81369, Munich, Germany
| | | | - Martin Häner
- Sportsclinic Berlin, Department of Orthopedics, Martin Luther Hospital, Berlin-Grunewald, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany
| | - Tilman Hees
- Sportsclinic Berlin, Department of Orthopedics, Martin Luther Hospital, Berlin-Grunewald, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany
| | - Julian Mehl
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Andree Ellermann
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Natalie Mengis
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Christian Eberle
- ARCUS Sports Clinic, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Peter E Müller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Raymond Best
- Department of Orthopaedic and Sports Trauma Surgery, Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany
- Department of Sports Medicine and Orthopaedics, University of Tuebingen, Hoppe Seyler Strasse 5, 72074, Tuebingen, Germany
| | - Patricia M Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Andrea Achtnich
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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12
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Geyer S, Achtnich AE, Voss A, Berthold DP, Lutz PM, Imhoff AB, Martetschläger F. Iatrogenic instability of the acromioclavicular joint leads to ongoing impairment of shoulder function even following secondary surgical stabilization. Arch Orthop Trauma Surg 2023; 143:1877-1886. [PMID: 35220484 PMCID: PMC10030407 DOI: 10.1007/s00402-022-04387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 02/05/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE Iatrogenic instability of the acromioclavicular joint (ACJ) following distal clavicle excision (DCE) represents an infrequent pathology. Revision surgery to restore ACJ stability and alleviate concomitant pain is challenging due to altered anatomic relationships. The purpose of this study was to evaluate the used salvage techniques and postoperative functional and radiological outcomes in retrospectively identify patients with a painful ACJ following DCE. We hypothesized that iatrogenic instability leads to ongoing impairment of shoulder function despite secondary surgical stabilization. METHODS 9 patients with a painful ACJ after DCE (6 men, 3 women, 43.3 ± 9.4 years) were followed up at a minimum of 36 months after revision surgery. Besides range of motion (ROM), strength and function were evaluated with validated evaluation tools including the Constant score and the DASH score (Disability of the Arm, Shoulder and Hand questionnaire), specific AC Score (SACS), Nottingham Clavicle Score (NCS), Taft score and Acromioclavicular Joint Instability Score (AJI). Additionally, postoperative X-rays were compared to the unaffected side, measuring the coracoclavicular (CC) and acromioclavicular (AC) distance. RESULTS At follow-up survey (55.8 ± 18.8 months) all patients but one demonstrated clinical ACJ stability after arthroscopically assisted anatomical ACJ reconstruction with an autologous hamstring graft. Reconstruction techniques were dependent on the direction of instability. The functional results demonstrated moderate shoulder and ACJ scores with a Constant Score of 77.3 ± 15.4, DASH-score of 51.2 ± 23.4, SACS 32.6 ± 23.8, NCS 77.8 ± 14.2, AJI 75 ± 14.7 points and Taft Score 7.6 ± 3.4 points. All patients stated they would undergo the revision surgery again. Mean postoperative CC-distance (8.3 ± 2.8 mm) did not differ significantly from the contralateral side (8.5 ± 1.6 mm) (p > 0,05). However, the mean AC distance was significantly greater with 16.5 ± 5.8 mm compared to the contralateral side (3.5 ± 1.9 mm) (p = 0.012). CONCLUSION Symptomatic iatrogenic ACJ instability following DCE is rare. Arthroscopically assisted revision surgery with an autologous hamstring graft improved ACJ stability in eight out of nine cases (88.9%). However, the functional scores showed ongoing impairment of shoulder function and a relatively high overall complication rate (33.3%). Therefore, this study underlines the importance of precise preoperative indication and planning and, especially, the preservation of ACJ stability when performing AC joint resection procedures. LEVEL OF EVIDENCE Case series, LEVEL IV.
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Affiliation(s)
- Stephanie Geyer
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Andrea E Achtnich
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Andreas Voss
- Department of Trauma Surgery, University Medical Center, Regensburg, Germany
- Sporthopaedicum, Regensburg, Germany
| | - Daniel P Berthold
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Patricia M Lutz
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Andreas B Imhoff
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany
| | - Frank Martetschläger
- Department for Orthopaedic Sports Medicine, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany.
- Deutsches Schulterzentrum, ATOS Klinik München, Effnerstr. 38, 81925, Munich, Germany.
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13
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Geyer S, Siebler J, Eggers F, Münch LN, Berthold DP, Imhoff AB, Siebenlist S, Scheiderer B. Influence of sportive activity on functional and radiographic outcomes following reverse total shoulder arthroplasty: a comparative study. Arch Orthop Trauma Surg 2023; 143:1809-1816. [PMID: 35092467 PMCID: PMC10030429 DOI: 10.1007/s00402-022-04344-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/03/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND The purpose of the present study was to compare the functional and radiographic outcomes following reverse total shoulder arthroplasty (RTSA) in a senior athletic and non-athletic population. MATERIAL AND METHODS In this retrospective cohort study, patients who underwent RTSA between 06/2013 and 04/2018 at a single institution were included. Minimum follow-up was 2 years. A standardized questionnaire was utilized for assessment of patients' pre- and postoperative physical fitness and sportive activity. Patients who resumed at least one sport were assigned to the athletic group, while patients who ceased participating in sports were assigned to the non-athletic group. Postoperative clinical outcome measures included the Constant score (CS), American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and visual analog scale (VAS) for pain. Active shoulder range of motion (ROM) and abduction strength were assessed. Radiographic evaluation was based on a standardized core set of parameters for radiographic monitoring of patients following shoulder arthroplasty. RESULTS Sixty-one of 71 patients (85.9%; mean age: 72.1 ± 6.6 years) were available for clinical and radiographic follow-up at a mean of 47.1 ± 18.1 months. Thirty-four patients (55.7%) were assigned to the athletic group and 27 patients (44.3%) to the non-athletic group. The athletic group demonstrated significantly better results for CS (P = 0.002), ASES score (P = 0.001), SST (P = 0.001), VAS (P = 0.022), active external rotation (P = 0.045) and abduction strength (P = 0.016) compared to the non-athletic group. The overall rate of return to sport was 78.0% at an average of 5.3 ± 3.6 months postoperatively. Incomplete radiolucent lines (RLL) around the humeral component were found significantly more frequently in the athletic group compared to the non-athletic group (P = 0.019), whereas the occurrence of complete RLLs around the implant components was similar (P = 0.382). Scapular notching was observed in 18 patients (52.9%) of the athletic group and 12 patients (44.9%) of the non-athletic group (P = 0.51). The overall rate for revision surgery was 8.2%, while postoperative complications were encountered in 3.3% of cases. CONCLUSION At mid-term follow-up, the athletic population demonstrated significantly better clinical results following RTSA without a higher rate of implant loosening and scapular notching when compared to non-athletic patients. However, incomplete radiolucency around the humeral component was observed significantly more often in the athletic group. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jakob Siebler
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Felipe Eggers
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Lukas N Münch
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Plath J, Otto A, Förch S, Siebenlist S, Grosser B, Mayr E, Imhoff AB, Lenich A. Arthroscopic rod technique compared to stress ultrasound in the dynamic evaluation of lateral ligament instabilities of the elbow. Arch Orthop Trauma Surg 2023; 143:2087-2093. [PMID: 35816195 PMCID: PMC10030401 DOI: 10.1007/s00402-022-04491-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose was to compare the arthroscopic rod technique to stress ultrasound in the dynamic assessment of lateral elbow instabilities. MATERIALS AND METHODS Fifteen elbows of eight specimen with a mean age of 66.4 ± 13.3 years were assessed in a prone position following a defined dissection setup. After evaluation of the native status, an arthroscopic dissection of the radial collateral ligament (RCL) or lateral ulnar collateral ligament (LUCL), and finally of entire capsuloligamentous structures was performed. Three raters examined each state (native, RCL or LUCL lesion, complete lesion) with the arthroscopic rod technique in 90° flexion and with stress ultrasound in 30 and 90° flexion. The intra-class correlation coefficient (ICC) was calculated to assess the interrater reliability as well as test-retest reliability for each testing modality (arthroscopy and ultrasound). RESULTS The arthroscopic rod technique showed a superior interrater and test-retest reliability of 0.953 and 0.959 (P < 0.001), respectively, when compared to stress ultrasound with an ICC of 0.4 and 0.611 (P < 0.001). A joint space opening during arthroscopy of > 6 mm humero-ulnar or > 7 mm humero-radial was indicative for a lateral collateral ligament lesion. However, a differentiation between an isolated RCL or LUCL tear was not possible. A lateral joint opening of ≥ 9 mm was only observed in complete tears of the lateral capsuloligamentous complex. CONCLUSIONS The arthroscopic rod technique showed a superior interrater and test-retest reliability when compared to stress ultrasound. Arthroscopic assessment for radial elbow instability was found to be reliable and reproducible. A joint gapping ≥ 9 mm in the arthroscopic evaluation is a sign for a complete insufficiency of the radial capsuloligamentous complex. However, it is not possible to precisely distinguish between a lesion of the RCL or LUCL by arthroscopy. On the basis of our results, dynamic ultrasound testing may be inappropriate to objectify lateral elbow instability.
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Affiliation(s)
- Johannes Plath
- Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
| | - Alexander Otto
- Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
- Department of Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Stefan Förch
- Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Sebastian Siebenlist
- Department of Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Bianca Grosser
- Department of Pathology, University Hospital of Augsburg, Augsburg, Germany
| | - Edgar Mayr
- Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Klinikum Rechts Der Isar, Technische Universitaet Muenchen, Muenchen, Germany
| | - Andreas Lenich
- Zentrum Für Ellenbogen- Und Schulter-Therapie (ZEST), Orthopädie Am Stiglmaierplatz, Munich, Germany
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Willinger L, Athwal KK, Holthof S, Imhoff AB, Williams A, Amis AA. Role of the Anterior Cruciate Ligament, Anterolateral Complex, and Lateral Meniscus Posterior Root in Anterolateral Rotatory Knee Instability: A Biomechanical Study. Am J Sports Med 2023; 51:1136-1145. [PMID: 36917838 PMCID: PMC10068405 DOI: 10.1177/03635465231161071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Injuries to the anterior cruciate ligament (ACL), Kaplan fibers (KFs), anterolateral capsule/ligament (C/ALL), and lateral meniscus posterior root (LMPR) have been separately linked to anterolateral instability. PURPOSE To investigate the contributions of the ACL, KFs, C/ALL, and LMPR to knee stability and to measure instabilities resulting from their injury. STUDY DESIGN Controlled laboratory study. METHODS Ten fresh-frozen human knees were tested robotically to determine restraints of knee laxity at 0° to 90° of flexion. An 88-N anterior-posterior force (anterior and posterior tibial translation), 5-N·m internal-external rotation, and 8-N·m valgus-varus torque were imposed and intact kinematics recorded. The kinematics were replayed after sequentially cutting the structures (order varied) to calculate their contributions to stability. Another 10 knees were tested in a kinematics rig with optical tracking to measure instabilities after sequentially cutting the structures across 0° to 100° of flexion. One- and 2-way repeated-measures analyses of variance with Bonferroni correction were used to find significance (P < .05) for the robotic and kinematics tests. RESULTS The ACL was the primary restraint for anterior tibial translation; other structures were insignificant (<10% contribution). The KFs and C/ALL resisted internal rotation, reaching 44% ± 23% (mean ± SD; P < .01) and 14% ± 13% (P < .05) at 90°. The LMPR resisted valgus but not internal rotation. Anterior tibial translation increased after ACL transection (P < .001) and after cutting the lateral structures from 70° to 100° (P < .05). Pivot-shift loading increased anterolateral rotational instability after ACL transection from 0° to 40° (P < .05) and further after cutting the lateral structures from 0° to 100° (P < .01). CONCLUSION The anterolateral complex acts as a functional unit to provide rotatory stability. The ACL is the primary stabilizer for anterior tibial translation. The KFs are the most important internal rotation restraint >30° of flexion. Combined KFs + C/ALL injury substantially increased anterolateral rotational instability while isolated injury of either did not. LMPR deficiency did not cause significant instability with the ACL intact. CLINICAL RELEVANCE This study is a comprehensive biomechanical sectioning investigation of the knee stability contributions of the ACL, anterolateral complex, and LMPR and the instability after their transection. The ACL is significant in controlling internal rotation only in extension. In flexion, the KFs are dominant, synergistic with the C/ALL. LMPR tear has an insignificant effect with the ACL intact.
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Affiliation(s)
- Lukas Willinger
- Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | | | - Andreas B Imhoff
- Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Muench LN, Dyrna F, Otto A, Wellington I, Obopilwe E, Scheiderer B, Imhoff AB, Beitzel K, Mazzocca AD, Berthold DP. Superior Capsular Reconstruction Partially Restores Native Glenohumeral Joint Loads In A Dynamic Biomechanical Shoulder Model. Arthroscopy 2023:S0749-8063(23)00199-8. [PMID: 36868531 DOI: 10.1016/j.arthro.2023.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE To evaluate the effect of an irreparable posterosuperior rotator cuff tear (PSRCT) on glenohumeral joint loads and to quantify improvement following superior capsular reconstruction (SCR) using an acellular dermal allograft. METHODS Ten fresh-frozen cadaveric shoulders were tested using a validated dynamic shoulder simulator. A pressure mapping sensor was placed between the humeral head and glenoid surface. Each specimen underwent the following conditions: (1) native, (2) irreparable PSRCT, (3) SCR using a 3mm-thick acellular dermal allograft. Glenohumeral abduction angle (gAA) and superior humeral head migration (SM) were measured using 3D motion tracking software. Cumulative deltoid force (cDF) and glenohumeral contact mechanics, including contact area (gCA) and contact pressure (gCP), were assessed at rest,15°,30°,45°, and maximum angle of glenohumeral abduction. RESULTS The PSRCT resulted in a significant decrease of gAA along with an increase in SM, cDF, and gCP (P<.001, respectively). SCR did not restore native gAA (P<.001), however, SM was significantly reduced (P<.001). Further, SCR significantly reduced deltoid forces at 30° (P=.007) and 45° of abduction (P=.007) when compared to the PSRCT. SCR did not restore native cDF at 30°(P=.015), 45°(P<.001), and maximum angle (P<.001) of glenohumeral abduction. Compared to the PSRCT, SCR resulted in a significant decrease of gCP at 15°(P=.008), 30°(P=.002), and 45°(P=.006). However, SCR did not completely restore native gCP at 45° (P=.038) and maximum abduction angle (P=.014). CONCLUSION In this dynamic shoulder model, SCR only partially restored native glenohumeral joint loads. However, SCR significantly decreased glenohumeral contact pressure, cumulative deltoid forces, and superior migration, while increasing abduction motion, when compared to the posterosuperior rotator cuff tear. CLINICAL RELEVANCE These observations raise concerns regarding the true joint preserving potential of SCR for an irreparable posterosuperior rotator cuff tear, along with its ability to delay progression of cuff tear arthropathy and eventual conversion to reverse shoulder arthroplasty.
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Affiliation(s)
- Lukas N Muench
- Department of Sports Orthopaedics, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
| | | | - Alexander Otto
- Department of Sports Orthopaedics, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Ian Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Bastian Scheiderer
- Department of Sports Orthopaedics, Technical University of Munich, Germany
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Technical University of Munich, Germany
| | - Knut Beitzel
- Arthroscopy and Orthopedic Sportsmedicine, ATOS Orthoparc Clinic, Cologne, Germany
| | - Augustus D Mazzocca
- Massachusetts General Hospital, Massachusetts General Brigham, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel P Berthold
- Department of Sports Orthopaedics, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
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Forkel P, Noack J, Hinz M, Imhoff AB, Wörtler K, Feucht MJ. Coronal extrusion of the lateral meniscus does not increase after pullout repair of the posterior root of the lateral meniscus at short-term follow-up. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04815-z. [PMID: 36847859 PMCID: PMC10374772 DOI: 10.1007/s00402-023-04815-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Posterior lateral meniscus root (PLMR) tears are injuries that commonly occur together with anterior cruciate ligament (ACL) tears. The aim of this study was to evaluate the clinical and radiological outcome of PLMR repair accompanying ACL reconstruction. Specifically, PLMR healing rates, meniscal extrusion behavior and their influence on patient-reported outcome measures (PROMs) were analyzed. It was hypothesized that PLMR repair shows satisfactory healing rates and coronal meniscal extrusion does not increase significantly following PLMR repair. METHODS Patients that underwent PLMR repair between 2014 and 2019 were evaluated at least 12 months postoperatively. At follow-up, magnetic resonance imaging (MRI) was performed in order to evaluate the PLMR healing behavior (complete vs. partial vs. no healing) as well as the coronal and sagittal meniscal extrusion in comparison with the preoperative MRI. Additionally, patient-reported outcome measures (PROMs; Lysholm score, International Knee Documentation Committee subjective knee form [IKDC]) were compiled. Pre- and postoperative meniscal extrusion were tested for statistical significance using the paired t test. The Kruskal-Wallis test was used to compare extrusion values and PROMs in relation to different healing states. A correlation analysis was conducted using the Pearson correlation coefficient between differences in meniscal extrusion and PROMs. RESULTS Out of 25 patients, 18 patients (72.0%; 11 male and seven female) were available for final assessment at a mean follow-up of 40.8 ± SD 17.5 months. One revision PLMR repair was performed five months after the initial repair. In 14 cases (77.8%), healing of the lateral meniscus was observed (6 × complete, 8 × partial). Coronal extrusion of the lateral meniscus did not increase significantly following PLMR repair (2.0 ± 1.5 mm vs. 2.1 ± 1.3 mm; p = 0.645). Sagittal extrusion increased significantly (25.7 ± 2.4 mm vs. 27.0 ± 1.4 mm; p < 0.001). The healing status of the PLMR showed no significant association with meniscal extrusion or PROMs (p > 0.05). But a higher increase in coronal meniscal extrusion negatively affected PROMs (Lysholm score: p = 0.046, r = - 0.475; IKDC: p = 0.003, r = - 0.651). CONCLUSION High healing rates of the PLMR and no significant increase in coronal extrusion may be expected following combined PLMR repair and ACL reconstruction. But a greater increase in postoperative coronal meniscal extrusion correlates with less favorable clinical results. A greater increase in sagittal extrusion was observed, but this did not influence the clinical outcome. LEVEL OF EVIDENCE Retrospective Case Series; IV.
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Affiliation(s)
- Philipp Forkel
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.,Raphaelsklinik, Münster, Germany
| | - Jonas Noack
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Klaus Wörtler
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias J Feucht
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.,Diakonie-Klinikum Stuttgart, Stuttgart, Germany
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Rupp MC, Lindner F, Winkler PW, Muench LN, Mehl J, Imhoff AB, Siebenlist S, Feucht MJ. Clinical Effect of Isolated Lateral Closing Wedge Distal Femoral Osteotomy Compared to Medial Opening Wedge High Tibial Osteotomy for the Correction of Varus Malalignment: A Propensity Score-Matched Analysis. Am J Sports Med 2023; 51:437-445. [PMID: 36629434 PMCID: PMC9909033 DOI: 10.1177/03635465221142615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Recent evidence questions the role of medial opening wedge high tibial osteotomy (mowHTO) in the correction of femoral-based varus malalignment because of the potential creation of an oblique knee joint line. However, the clinical effectiveness of alternatively performing an isolated lateral closing wedge distal femoral osteotomy (lcwDFO), in which the mechanical unloading effect in knee flexion may be limited, is yet to be confirmed. PURPOSE/HYPOTHESIS The purpose of this article was to compare clinical outcomes between patients undergoing varus correction via isolated lcwDFO or mowHTO, performed according to the location of the deformity, in a cohort matched for confounding variables. It was hypothesized that results from undergoing isolated lcwDFO for symptomatic varus malalignment would not significantly differ from the results after mowHTO. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Consecutive patients who underwent isolated mowHTO or lcwDFO according to a tibial- or femoral-based symptomatic varus deformity between January 2010 and October 2019 were enrolled. Confounding factors, including age at surgery, sex, body mass index, preoperative femorotibial axis, and postoperative follow-up, were matched using propensity score matching. The International Knee Documentation Committee (IKDC) Subjective Knee Form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm score, Tegner Activity Scale, and visual analog scale (VAS) for pain were collected preoperatively and at a minimum of 24 months postoperatively. RESULTS Of 535 knees assessed for eligibility, 50 knees (n = 50 patients, n = 25 per group) were selected by propensity score matching. Compared with preoperatively, both the mowHTO group (IKDC, 55.1 ± 16.5 vs 71.3 ± 14.7, P = .002; WOMAC, 22.0 ± 18.0 vs 9.6 ± 10.8, P < .001; Lysholm, 55.2 ± 23.1 vs 80.7 ± 16, P < .001; VAS, 4.1 ± 2.4 vs 1.6 ± 1.8, P < .001) and the lcwDFO group (IKDC, 49.4 ± 14.6 vs 66 ± 20.1, P = .003; WOMAC, 25.2 ± 17.0 vs 12.9 ± 17.6, P = .003; Lysholm, 46.5 ± 15.6 vs 65.4 ± 28.7, P = .011; VAS, 4.5 ± 2.2 vs 2.6 ± 2.5, P = .001) had significantly improved at follow-up (80 ± 20 vs 81 ± 43 months). There were no significant differences between the groups at baseline, at final follow-up, or in the amount of clinical improvement in any of the outcome parameters (P > .05; respectively). CONCLUSION Performing both mowHTO or lcwDFO yields significant improvement in clinical outcomes if performed at the location of the deformity of varus malalignment. These findings confirm the clinical effectiveness of performing an isolated lcwDFO in femoral-based varus malalignment, which is comparable with that of mowHTO in the correction of varus malalignment.
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Affiliation(s)
- Marco-Christopher Rupp
- Department of Orthopaedic Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany,Marco-Christopher Rupp, MD, Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, Munich, 81675, Germany ()
| | - Felix Lindner
- Department of Orthopaedic Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany,Marco-Christopher Rupp, MD, Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, Munich, 81675, Germany ()
| | - Philipp W. Winkler
- Department of Orthopaedic Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N. Muench
- Department of Orthopaedic Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias J. Feucht
- Orthopaedic Clinic Paulinenhilfe, Diakonie-Hospital, Stuttgart, Germany,Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Themessl A, Wagner T, Rupp MC, Degenhardt H, Woertler K, Hatter KA, Imhoff AB, Siebenlist S, Pogorzelski J. "Functional outcomes and MRI-based tendon healing after (antero-) superior rotator cuff repair among patients under 50 years: retrospective analysis of traumatic versus non-traumatic rotator cuff tears". BMC Musculoskelet Disord 2023; 24:52. [PMID: 36670374 PMCID: PMC9862981 DOI: 10.1186/s12891-023-06174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Rotator cuff tears among patients under 50 years either result from an adequate trauma or are considered non-traumatic due to work-related or athletic overuse. The impact of these different mechanisms on postoperative functional outcomes and tendon healing has not yet been fully understood. Therefore, it was the purpose of this study to investigate the influence of etiology of (antero-)superior rotator cuff tears on postoperative outcomes and the healing rates after arthroscopic rotator cuff repair in a young patient population. METHODS Patients under 50 years who underwent arthroscopic rotator cuff repair between 2006-2017 for an anterosuperior rotator cuff tear with a minimum follow up of 24 months were included in this study. Revision surgeries or reconstructive concomitant procedures other than long head of the biceps tenodesis were excluded. Patients were divided into two groups according to the etiology of their rotator cuff tear (traumatic vs. non-traumatic). Demographic and outcome scores including the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score (CS), bilateral strength measurements and postoperative tendon integrity evaluated on magnetic resonance imaging (MRI) were assessed and compared between both groups. RESULTS The mean follow up for this study was 55.6 months (24 - 158). Twenty-one patients (50.0%) had a traumatic RCT and 21 patients (50.0%) had a non-traumatic tear. Outcome scores did not differ significantly between groups. Strength measurements of the supraspinatus revealed significantly decreased force of the affected side as opposed to the contralateral side (p = 0.001), regardless of etiology. Retear rates were similar in both groups (37.5% and 33.3%, p = n.s.). Cuff integrity at follow-up was not predictive of superior scores or strength. CONCLUSION Surgical treatment of traumatic and non-traumatic RCT yields good clinical results in patients under the age of 50. The etiology of the rotator cuff tear did not significantly affect postoperative outcomes or healing rates. About one third of the patients suffered from a retear postoperatively, however retears were not predictive of inferior outcomes at midterm follow-up. STUDY DESIGN Level III. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Alexander Themessl
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Timon Wagner
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marco-Christopher Rupp
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Hannes Degenhardt
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Klaus Woertler
- grid.6936.a0000000123222966Department of Radiology, Technical University of Munich, Munich, Germany
| | - Kate A. Hatter
- grid.189509.c0000000100241216Department of Surgery/ Emergency Medicine, Duke University Hospital, Durham, NC USA
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jonas Pogorzelski
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
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Szalay A, Runer A, Ehmann Y, Imhoff AB, Mehl J, Achtnich A. Kindliche vordere Kreuzbandruptur mit komplexer Außenmeniskusverletzung und Knorpelfragmentablösung der posterolateralen Tibia. Arthroskopie 2023. [DOI: 10.1007/s00142-022-00587-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
ZusammenfassungEin 11-jähriger Junge erleidet ein Distorsionstrauma des Kniegelenks mit einer Ruptur des vorderen Kreuzbands (VKB), Läsion des Außenmeniskus und Ablösung eines Knorpelfragments am posterolateralen Tibiaplateau. Aufgrund der konträren Nachbehandlungsschemata dieser schwerwiegenden Kombinationsverletzung erfolgt eine zweizeitige operative Versorgung. In einem ersten arthroskopischen Eingriff werden die Meniskus- und Knorpelverletzung behandelt. Nach stattgefundener Knorpeleinheilung erfolgt eine epiphysenschonende Rekonstruktion des vorderen Kreuzbands.
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Muench LN, Kia C, Murphey M, Obopilwe E, Cote MP, Imhoff AB, Mazzocca AD, Berthold DP. Elliptical heads result in increased glenohumeral translation along with micro-motion of the glenoid component during axial rotation in total shoulder arthroplasty. Arch Orthop Trauma Surg 2023; 143:177-187. [PMID: 34216260 PMCID: PMC9886581 DOI: 10.1007/s00402-021-04018-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Elliptical-shaped humeral head prostheses have recently been proposed to reflect a more anatomic shoulder replacement. However, its subsequent effect on micro-motion of the glenoid component is still not understood. MATERIALS AND METHODS Six fresh-frozen, cadaveric shoulders (mean age: 62.7 ± 9.2 years) were used for the study. Each specimen underwent total shoulder arthroplasty using an anatomic stemless implant. At 15°, 30°, 45° and 60° of glenohumeral abduction, 50° of internal and external rotations in the axial plane were alternatingly applied to the humerus with both an elliptical and spherical humeral head design. Glenohumeral translation was assessed by means of a 3-dimensional digitizer. Micro-motion of the glenoid component was evaluated using four high-resolution differential variable reluctance transducer strain gauges, placed at the anterior, posterior, superior, and inferior aspect of the glenoid component. RESULTS The elliptical head design showed significantly more micro-motion in total and at the superior aspect of glenoid component during external rotation at 15° (total: P = 0.004; superior: P = 0.004) and 30° (total: P = 0.045; superior: P = 0.033) of abduction when compared to the spherical design. However, during internal rotation, elliptical and spherical heads showed similar amounts of micro-motion at the glenoid component at all tested abduction angles. When looking at glenohumeral translation, elliptical and spherical heads showed similar anteroposterior and superoinferior translation as well as compound motion during external rotation at all tested abduction angles. During internal rotation, the elliptical design resulted in significantly more anteroposterior translation and compound motion at all abduction angles when compared to the spherical design (P < 0.05). CONCLUSION In the setting of total shoulder arthroplasty, the elliptical head design demonstrated greater glenohumeral translation and micro-motion at the glenoid component during axial rotation when compared to the spherical design, potentially increasing the risk for glenoid loosening in the long term. LEVEL OF EVIDENCE Controlled Laboratory Study.
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Affiliation(s)
- Lukas N. Muench
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Matthew Murphey
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Mark P. Cote
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | - Daniel P. Berthold
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
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Geyer S, Lacheta L, Seilern Und Aspang J, Willinger L, Lutz PM, Lappen S, Imhoff AB, Siebenlist S. Patient satisfaction, joint stability and return to sports following simple elbow dislocations: surgical versus non-surgical treatment. Arch Orthop Trauma Surg 2023; 143:1481-1489. [PMID: 35220457 PMCID: PMC9957866 DOI: 10.1007/s00402-022-04383-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE While conservative management is commonly promoted for simple elbow dislocations, the importance of primary surgical treatment in these injuries is still undetermined. The objective of this study was to report patient-reported outcome measures (PROMs), return to sports (RTS) and joint stability using ultrasound in patients following conservative or surgical treatment after simple elbow dislocation. METHODS Patients with a minimum follow-up of 24 months after conservative (CT) or surgical treatment (ST) following simple elbow dislocation were included in this retrospective study. To evaluate patients' postoperative outcome and satisfaction, the Elbow Self-Assessment Score (ESAS) was used, and validated scores such as the Mayo elbow performance score (MEPS), the Quick Disability of Arm and Shoulder Score (Quick-DASH) and RTS were assessed. For objective assessment of residual joint instability, a standardized clinical examination as well as a dynamic ultrasound evaluation of the affected and the contralateral elbow was performed. RESULTS Forty-four patients (26 women, 18 men) with an average age of 41.5 ± 15.3 years were available for follow-up survey (65.5 ± 30.4 months; range 26-123). 21 patients were treated conservatively and twenty-three patients received surgical treatment. CT and ST resulted in similar outcome with regard to ROM, ESAS (CT: 99.4 ± 1.5; ST: 99.8 ± 0.3), MEPS (CT: 97.3 ± 6.8 points; ST: 98.7 ± 3.3) and Quick-DASH (CT: 7.8 ± 10.4; ST: 6.3 ± 7.9) (n.s.). There was no difference in elbow stability and laxity measured by ultrasound between the study groups and compared to the healthy elbow (n.s.). Two patients of the CT group (10%) complained about persistent subjective elbow instability. RTS was faster after surgical compared to conservative treatment (p = 0.036). CONCLUSION Both, conservative and surgical treatment results in high patient satisfaction and good-to-excellent functional outcome after simple elbow dislocation. Even though ultrasound evaluation showed no significant differences in joint gapping between groups, 10% of conservatively treated patients complained about severe subjective instability. Surgically treated patients returned faster to their preoperatively performed sports. Thus, primary surgical treatment may be beneficial for high demanding patients. LEVEL OF EVIDENCE Therapeutic study, Level III.
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Affiliation(s)
- Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Lucca Lacheta
- Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Lukas Willinger
- Department of Trauma Surgery, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Patricia M Lutz
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sebastian Lappen
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
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Berthold DP, Muench LN, Dyrna F, Mazzocca AD, Garvin P, Voss A, Scheiderer B, Siebenlist S, Imhoff AB, Beitzel K. Current concepts in acromioclavicular joint (AC) instability - a proposed treatment algorithm for acute and chronic AC-joint surgery. BMC Musculoskelet Disord 2022; 23:1078. [PMID: 36494652 PMCID: PMC9733089 DOI: 10.1186/s12891-022-05935-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There exists a vast number of surgical treatment options for acromioclavicular (AC) joint injuries, and the current literature has yet to determine an equivocally superior treatment. AC joint repair has a long history and dates back to the beginning of the twentieth century. MAIN BODY Since then, over 150 different techniques have been described, covering open and closed techniques. Low grade injuries such as Type I-II according to the modified Rockwood classification should be treated conservatively, while high-grade injuries (types IV-VI) may be indicated for operative treatment. However, controversy exists if operative treatment is superior to nonoperative treatment, especially in grade III injuries, as functional impairment due to scapular dyskinesia or chronic pain remains concerning following non-operative treatment. Patients with a stable AC joint without overriding of the clavicle and without significant scapular dysfunction (Type IIIA) may benefit from non-interventional approaches, in contrast to patients with overriding of the clavicle and therapy-resistant scapular dysfunction (Type IIIB). If these patients are considered non-responders to a conservative approach, an anatomic AC joint reconstruction using a hybrid technique should be considered. In chronic AC joint injuries, surgery is indicated after failed nonoperative treatment of 3 to 6 months. Anatomic AC joint reconstruction techniques along with biologic augmentation (e.g. Hybrid techniques, suture fixation) should be considered for chronic high-grade instabilities, accounting for the lack of intrinsic healing and scar-forming potential of the ligamentous tissue in the chronic setting. However, complication and clinical failure rates remain high, which may be a result of technical failures or persistent horizontal and rotational instability. CONCLUSION Future research should focus on addressing horizontal and rotational instability, to restore native physiological and biomechanical properties of the AC joint.
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Affiliation(s)
- Daniel P. Berthold
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,grid.411095.80000 0004 0477 2585Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Lukas N. Muench
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Felix Dyrna
- Department of Trauma, Hand and Reconstructive Surgery University Hospital Münster, Munich, Germany
| | - Augustus D. Mazzocca
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Patrick Garvin
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Andreas Voss
- grid.7727.50000 0001 2190 5763Department of Trauma Surgery, University Regensburg, Regensburg, Germany
| | - Bastian Scheiderer
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Knut Beitzel
- Arthroscopy and Orthopedic Sportsmedicine, ATOS Orthoparc Clinic, Cologne, Germany
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Muench LN, Achtnich A, Krivec L, Diermeier T, Woertler K, Braun S, Imhoff AB, Willinger L. Clinical outcome and healing rate after meniscal bucket handle tear repair. BMC Musculoskelet Disord 2022; 23:1063. [PMID: 36471335 PMCID: PMC9721037 DOI: 10.1186/s12891-022-06037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Reports combining patient-reported outcome measures, clinical evaluation, and radiographic assessment of postoperative healing after arthroscopic repair of bucket-handle meniscal tears (BHMT) are scarce. METHODS Patients who underwent arthroscopic repair for acute traumatic BHMTs between October 2011 and March 2016 with a minimum follow-up of two years were included. Postoperative outcome scores comprised the International Knee Documentation Society Score (IKDC), Lysholm score, Tegner activity score (TAS), and visual analog scale (VAS) for pain. Clinical meniscal healing failure was assessed according to Barrett's criteria. Side-to-side difference in knee laxity was measured using KT-2000. Radiographic healing was assessed by 3-Tesla magnetic resonance imaging (MRI) and classified according to Henning's criteria at final follow-up. RESULTS Forty patients with a mean age of 32.0 ± 11.5 years were available for follow-up after 51.8 ± 14.3 months. Revision surgery by means of arthroscopic partial meniscectomy was performed in four patients (10%) prior to the follow-up visit. The clinical healing rate was 83.3% at final follow-up. Mean IKDC score was 82.8 ± 13.8 and Lysholm score was 77.4 ± 24.8. Of all patients, 87.5% reached or exceeded the patient-acceptable symptomatic state (PASS) criteria for the IKDC score at final follow-up. The median TAS was 6 and VAS for pain was 0.46 ± 0.9. Side-to-side difference in knee laxity was higher in patients with concomitant ACL reconstruction (2.1 ± 2.7 mm) compared to isolated BHMTs (1.0 ± 2.0 mm). MR examination showed 69.4% healed, 25.0% partially healed, and 5.6% unhealed menisci. CONCLUSION Patients who underwent repair for acute traumatic BHMTs achieved good to excellent clinical outcome along with a high rate of meniscal healing at a minimum follow-up of two years. Clinical and radiological healing rates were similarly satisfactory and most patients exceeded the PASS criteria for the IKDC score. Patients were able to reach a high postoperative activity level. LEVEL OF EVIDENCE Case Series; IV.
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Affiliation(s)
- Lukas N. Muench
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
| | - Andrea Achtnich
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
| | - Lukas Krivec
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
| | - Theresa Diermeier
- grid.460088.20000 0001 0547 1053Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Klaus Woertler
- grid.6936.a0000000123222966Department of Radiology, Klinikum rechts der Isar, TU Munich, Munich, Germany
| | - Sepp Braun
- grid.487341.dGelenkpunkt - Sports- and Joint Surgery Innsbruck, Innsbruck, Austria ,UMIT - OSMI- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University UMIT, Hall/ Tirol, Austria
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
| | - Lukas Willinger
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
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Lutz PM, Geyer S, Winkler PW, Irger M, Berthold DP, Feucht MJ, Imhoff AB, Forkel P. Reliable ligamentous stability and high return-to-sport rates after arthroscopic reduction and internal fixation of tibial eminence fractures. Arch Orthop Trauma Surg 2022; 142:3623-3631. [PMID: 34009463 PMCID: PMC9596592 DOI: 10.1007/s00402-021-03961-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE To investigate functional and clinical outcomes, and physical activity after arthroscopic suture fixation of tibial eminence fractures with regard to postoperative stability, range of motion (ROM), complications, and return to sports. METHODS Patients undergoing arthroscopic reduction and internal fixation (ARIF) of tibial eminence fractures using a suture fixation technique were included. Outcome was evaluated retrospectively after a minimum follow-up of 24 months using KT-1000 arthrometer measurements, clinical examination, outcome scores (Lysholm score, Tegner Activity Scale), and a questionnaire about sport activities. RESULTS A total of 23 patients (44% male, 57% female) with a mean age of 25 ± 15 years were included. Mean follow-up was 57 ± 25 months. KT-1000 arthrometer measurements of anterior tibial translation revealed a mean side-to-side difference of 0.9 ± 1.0 mm. Clinical examination showed 100% normal or nearly normal anterior translation of the tibia. Two patients (9%) received an ACL reconstruction due to traumatic ACL re-instability and were, therefore, considered as failures. An extension deficit concerning hyperextension occurred in 29% of patients postoperatively. Further postoperative complications occurred in 14% of patients and included postoperative stiffness with ROM limitations and secondary dislocation of a fragment. Mean postoperative Lysholm score was 89 ± 14. Comparing pre- and postoperative values, no significant change of the Tegner Activity Scale was observed. All patients (failures excluded) returned to high impact sports activities after ARIF. CONCLUSION Excellent reliable ligamentous stability and high rates of return to high impact sports can be expected after ARIF using a suture fixation technique for type II-IV tibial eminence fractures. Complications, such as limitations in ROM, commonly occur in up to 30% after ARIF. Therefore, regular follow-up examinations remain important in this usually young patient cohort. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Patricia M Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Stephanie Geyer
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp W Winkler
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Markus Irger
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel P Berthold
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias J Feucht
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp Forkel
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Lappen S, Geyer S, Kadantsev P, Hinz M, Kleim B, Degenhardt H, Imhoff AB, Siebenlist S. All-suture anchors for distal biceps tendon repair: a preliminary outcome study. Arch Orthop Trauma Surg 2022; 143:3271-3278. [PMID: 36416943 DOI: 10.1007/s00402-022-04690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study was to retrospectively evaluate the clinical outcome of double intramedullary all-suture anchors' fixation for distal biceps tendon ruptures. MATERIALS AND METHODS A retrospective case series of patients who underwent primary distal biceps tendon repair with all-suture anchors was conducted. Functional outcome was assessed at a minimum follow-up of at 12 months based on the assessments of the Mayo Elbow Performance Score (MEPS), Andrews-Carson Score (ACS), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the Visual Analog Scale (VAS) for pain. Maximum isometric strength test for flexion and supination as well as postoperative range of motion (ROM) were determined for both arms. RESULTS 23 patients treated with all-suture anchors were assessed at follow-up survey (mean age 56.5 ± 11.4 years, 96% male). The follow-up time was 20 months (range Q0.25-Q0.75, 15-23 months). The following outcome results were obtained: MEPS 100 (range Q0.25-Q0.75, 100-100); ACS 200 (range Q0.25-Q0.75, 195-200); QuickDASH 31 (range Q0.25-Q0.75, 30-31); VAS 0 (range Q0.25-Q0.75, 0-0). The mean strength compared to the uninjured side was 95.6% (range Q0.25-Q0.75, 80.9-104%) for flexion and 91.8 ± 11.6% for supination. There was no significant difference in ROM or strength compared to the uninjured side and no complications were observed in any patient. CONCLUSION Distal biceps tendon refixation using all-suture anchors provides good-to-excellent results in terms of patient-reported and functional outcome. This repair technique appears to be a viable surgical option, although further long-term results are needed. LEVEL OF EVIDENCE Level IV (case series).
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Affiliation(s)
- Sebastian Lappen
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie Geyer
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Pavel Kadantsev
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Maximilian Hinz
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benjamin Kleim
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Hannes Degenhardt
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Winkler PW, Geyer S, Walzl D, Woertler K, Paul J, Siebenlist S, Imhoff AB, Achtnich A. Favorable long-term clinical and radiologic outcomes with high survivorship after autologous osteochondral transplantation of the talus. Knee Surg Sports Traumatol Arthrosc 2022; 31:2166-2173. [PMID: 36394584 PMCID: PMC10183420 DOI: 10.1007/s00167-022-07237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate long-term clinical and radiologic outcomes of patients undergoing autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and to perform a correlation analysis between clinical and radiologic outcomes. METHODS Thirty-five patients with a mean age of 32.2 ± 8.9 years undergoing AOT for OLT between 1997 and 2003 were available for follow-up after an average of 19.1 ± 1.4 years. Demographic, surgical, and injury-related data were collected. After a minimum 18-year follow-up, patient-reported outcome scores (PROs) were collected, including the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Foot and Ankle Outcome Score (FAOS), Tegner Activity Scale, and Visual Analogue Scale (VAS) for pain of the ankle. The Lysholm Score and VAS for pain of the knee were collected to assess donor-site morbidity. Magnetic resonance imaging scans were obtained to conduct an assessment of the replaced cartilage using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scoring system. Any revision surgery (except symptomatic hardware removal and arthroscopic debridement) was defined as clinical failure. RESULTS Favorable clinical and radiologic (MOCART score, 73.7 ± 16.7 points) outcomes without any donor-site morbidities were observed. Twenty-three (65.7%) patients were satisfied or very satisfied with the surgical treatment. Fourteen (40.0%) and 25 (71.4%) patients had no or minor limitations in their athletic and working performance, respectively. A significant correlation between the MOCART and the FAOS Sport and Recreational activities subscale was found (rs, 0.491; p = 0.033). Six (17.1%) patients met the criteria for clinical failure an average of 12.2 ± 6.6 years after AOT. Survival analysis demonstrated a mean estimated time of survival of 21.3 years (95% CI [19.55, 22.96]) and a 20-year survival rate of 77.9%. CONCLUSION Autologous osteochondral transplantation to treat OLT achieves high patient satisfaction and favorable PROs with a 20-year survival rate of almost 80%. Given the high clinical efficacy of AOT, this procedure can be recommended as a safe and promising technique for the long-term therapy of OLT. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Philipp W Winkler
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie Geyer
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniela Walzl
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Klaus Woertler
- Musculoskeletal Radiology Section, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | | | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Andrea Achtnich
- Department of Sports Orthopaedics, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Muench LN, Berthold DP, Kia C, Obopilwe E, Cote MP, Imhoff AB, Scheiderer B, Elhassan BT, Beitzel K, Mazzocca AD. Biomechanical comparison of lower trapezius and latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears using a dynamic shoulder model. J Shoulder Elbow Surg 2022; 31:2392-2401. [PMID: 35671930 DOI: 10.1016/j.jse.2022.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the setting of irreparable posterosuperior rotator cuff tears (PSRCTs), lower trapezius transfer (LTT) may be anatomically better positioned for restoring the muscular force couple compared with latissimus dorsi transfer (LDT). The purpose of the study was to evaluate the effect of LTT and LDT on glenohumeral kinematics using a dynamic shoulder model. METHODS Ten fresh-frozen cadaveric shoulders (mean age: 56.5 ± 17.2 years) were tested using a dynamic shoulder simulator. The maximum abduction angle (MAA), superior humeral head migration (SHM), and cumulative deltoid forces (CDFs) were compared across 4 conditions: (1) native; (2) irreparable PSRCT; (3) LTT using an Achilles tendon allograft; and (4) LDT. MAA and SHM were measured using 3-dimensional motion tracking. CDF was recorded in real time throughout the dynamic abduction motion by load cells connected to actuators. RESULTS Compared to the native state, the PSRCT resulted in a significant decrease (Δ-24.1°; P < .001) in MAA, with a subsequent significant increase after LTT (Δ13.1°; P < .001) and LDT (Δ8.9°; P < .001). LTT achieved a significantly greater MAA than LDT (Δ4.2°; P = .004). Regarding SHM, both LTT (Δ-9.4 mm; P < .001) and LDT (Δ-5.0 mm; P = .008) demonstrated a significant decrease compared with the PSRCT state. LTT also achieved significantly less SHM compared with the LDT (Δ-4.4 mm; P = .011). Further, only the LTT resulted in a significant decrease in CDF compared with the PSRCT state (Δ-21.3 N; P = .048), whereas LTT and LDT showed similar CDF (Δ-11.3 N; P = .346). However, no technique was able to restore the MAA, SHM, and CDF of the native shoulder (P < .001, respectively). CONCLUSION LTT and LDT both achieved a significant increase in MAA along with significantly less SHM compared with the PSRCT state. Although LTT required significantly less compensatory deltoid forces compared with the PSRCT state, this was not observed for the LDT. Further, the LTT prevented loss of abduction motion and SHM more sufficiently. In the challenging treatment of irreparable PSRCTs, LTT may restore native glenohumeral kinematics more sufficiently, potentially leading to improved postoperative functional outcomes.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Cameron Kia
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Bassem T Elhassan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Department of Shoulder Surgery, ATOS Clinic, Cologne, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
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Ehmann YJ, Esser T, Seyam A, Rupp MC, Mehl J, Siebenlist S, Imhoff AB, Minzlaff P. Low postoperative complication rate with high survival rate and good clinical outcome 9 years after autologous chondrocyte transplantation of the knee joint. Arch Orthop Trauma Surg 2022; 143:2665-2674. [PMID: 36198844 PMCID: PMC10110693 DOI: 10.1007/s00402-022-04611-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/28/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To investigate postoperative complications and associated risk factors for failure following autologous chondrocyte transplantation ("ACT") as well as its long-term survival and clinical function. It was hypothesized that ACT is a safe technique for cartilage repair with a low incidence of postoperative complications and rare rates of revision surgery combined with a high long-term survival and good to excellent clinical outcome in long-term-follow-up. METHODS All patients undergoing ACT-Cs of the knee joint between 2006 and 2012 at the author's institution were included in this retrospective study. Concomitant procedures had been performed if necessary. Early postoperative complications, revision surgeries, failure and risk factors for those events were evaluated 6 months after the surgery. Long-term clinical outcome was assessed using the Lysholm Score, the Tegner Score, a 10-grade scale for satisfaction and the Visual Analogue Scale (VAS) at a minimum follow-up of 9 years postoperatively. Long-term survival was calculated using revision surgeries, clinical failures and conversion procedures to create a Kaplan-Meier analysis. A subgroup analysis for different defect locations was performed. 139 patients were included in this study (27% female/ 73%male; age 26.7 [21.7; 35.2] years). The median defect size was 4.0 [3.0; 6.0] cm2 (40% medial femoral condyle (MFC), 17% lateral femoral condyle (LFC), 36% patella, 19% trochlea). 97 (70%) of the patients had undergone previous surgery and 84 (60%) underwent concomitant procedures. RESULTS Postoperatively, 8% of patients had complications (4% bleeding, 2% arthrofibrosis, 2% infection), 7% of patients needed revision surgery. 12% of patients had a prolonged deficit in ROM, that did not require revision surgery. No significant difference in terms of complications was found between the patellofemoral and femorotibial group. Patients demonstrated good patient reported long-term outcomes 9-15 years after the index surgery (Tegner: 4.7 ± 1.8; VAS: 2.4 ± 2.1; Lysholm: 80 ± 14; satisfaction with operation: 7.3 ± 1.9). Survival rates were 88% at 9 years, 85% at 11 years, and 85% at 13 years after the index procedure. Reasons for failure included debridement of ACT (n = 4; 5%), revision ACT (n = 3, 3%), conversion to total knee arthroplasty (n = 3, 3%) and conversion to High tibial osteotomy (HTO) (n = 1; 1%)). CONCLUSION The present study indicates ACT as an effective treatment option for femorotibial- as well as patellofemoral cartilage defects with a high long-term survival and low conversion rate as well as good long-term results regarding knee function and satisfaction. Postoperative complications needing revision surgery are rare. Prolongated deficits of range of motion appear frequently up to six months especially in patellofemoral defects, but can often be successfully addressed by intensified physiotherapy without requiring an arthrolysis. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yannick J Ehmann
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Thekla Esser
- Department of Orthopedic Sports Medicine, Orthoclinic Agatharied, Agatharied, Germany
| | - Amr Seyam
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marco-Christopher Rupp
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Julian Mehl
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Philipp Minzlaff
- Department of Orthopedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Orthopedic Sports Medicine, Orthoclinic Agatharied, Agatharied, Germany
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Kleim BD, Hinz M, Geyer S, Scheiderer B, Imhoff AB, Siebenlist S. A 3-Dimensional Classification for Degenerative Glenohumeral Arthritis Based on Humeroscapular Alignment. Orthop J Sports Med 2022; 10:23259671221110512. [PMID: 35982830 PMCID: PMC9380229 DOI: 10.1177/23259671221110512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
Background Seminal classifications of degenerative arthritis of the shoulder (DAS) describe either cuff tear arthropathy in the coronal plane or primary osteoarthritis in the cross-sectional plane. None consider a biplanar eccentricity. Purpose/Hypothesis The purpose of this study was to investigate humeroscapular alignment (HSA) of patients with DAS in both the anteroposterior (A-P) and superoinferior (S-I) planes on computed tomography (CT) after 3-dimensional (3D) reconstruction and develop a classification based on biplanar HSA in 9 quadrants. It was hypothesized that biplanar eccentricity would occur frequently. Study Design Cross-sectional study; Level of evidence, 3. Methods The authors analyzed 130 CT scans of patients who had undergone shoulder arthroplasty. The glenoid center, trigonum, and inferior angle of the scapula were aligned in a single plane using 3D reconstruction software. Subluxation of the HSA was measured as the distance from the center of rotation of the humeral head to the scapular axis (line from trigonum through glenoid center) and was expressed as a percentage of the radius of the humeral head in both the A-P and the S-I directions. HSA was described in terms of A-P alignment first (posterior/central/anterior), then S-I alignment (superior/central/inferior), for a total of 9 different alignment combinations. Additionally, glenoid erosion was graded 1-3. Results Subluxation of the HSA was 74.1% posterior to 23.5% anterior in the A-P direction and 17.2% inferior to 68.6% superior in the S-I direction. A central HSA was calculated as between 20% posterior to 5% anterior (A-P) and 5% inferior to 20% superior (S-I), after a graphical analysis. Posterior subluxation >60% of the radius was labeled as extraposterior, and static acetabularization was labeled as extrasuperior. Overall, 21 patients had central-central, 40 centrosuperior, and 1 centroinferior alignment. Of 60 shoulders with posterior subluxation, alignment was posterocentral in 31, posterosuperior in 25, and posteroinferior in 5. There were 3 patients with anterocentral and 4 anterosuperior subluxation; in addition, 4 cases with extraposterior and 17 with extrasuperior subluxation were identified. Conclusion There was a high prevalence of biplanar eccentricity in DAS. The 3D classification system using combined HSA and glenoid erosion can be applied to describe DAS comprehensively.
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Affiliation(s)
- Benjamin D. Kleim
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Maximillian Hinz
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Stephanie Geyer
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Bastian Scheiderer
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Andreas B. Imhoff
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich,
Munich, Germany
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31
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Hackl M, Flury M, Kolling C, Nebelung W, Krauss CA, Kraemer NA, Heuberer PR, Laky B, Wellmann M, Pastor MF, Imhoff AB, Reuter S, Anderle G, Agneskirchner JD, Buess E. Results of Arthroscopic Revision Rotator Cuff Repair for Failed Open or Arthroscopic Repair: A Prospective Multicenter Study on 100 Cases. Am J Sports Med 2022; 50:2203-2210. [PMID: 35666098 DOI: 10.1177/03635465221097410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Retears after rotator cuff repair (RCR) have been associated with poor clinical results. Meaningful data regarding the role of arthroscopic revision RCR are sparse thus far. PURPOSE/HYPOTHESIS To investigate results after arthroscopic revision RCR. We hypothesized that (1) arthroscopic revision RCR would lead to improved outcomes, (2) the clinical results would be dependent on tendon integrity and (3) tear pattern, tendon involvement, and repair technique would influence clinical and structural results. STUDY DESIGN Case series; Level of evidence 4. METHODS During a 40-month period, 100 patients who underwent arthroscopic revision RCR were prospectively enrolled in this multicenter study. Outcomes were evaluated preoperatively, at 6 months (6M), and at 24 months (24M) using the Constant score (CS), the Oxford Shoulder Score (OSS), and the Subjective Shoulder Value (SSV). Tendon integrity at 2 years was analyzed using magnetic resonance imaging. A total of 13 patients (13%) were lost to follow-up, and 14 patients (14%) had a symptomatic retear before the 24M follow-up. RESULTS All clinical scores improved significantly during the study period (CS: preoperative, 44 ± 16; 6M, 58 ± 22; 24M, 69 ± 19 points; OSS: preoperative, 27 ± 8; 6M, 36 ± 11; 24M, 40 ± 9 points; SSV: preoperative, 43% ± 18%; 6M, 66% ± 24%; 24M, 75% ± 22%) (P < .01). At 2 years, a retear rate of 51.8% (43/83) and a surgical revision rate of 12.6% (11/87) were observed. Mean full-thickness tear size decreased from 5.00 ± 1.61 cm2 to 3.25 ± 1.92 cm2 (P = .041). Although the Sugaya score improved from 4.5 ± 0.9 to 3.7 ± 1.4 (P = .043), tendon integrity did not correlate with better outcome scores. Previous open RCR, involvement of the subscapularis, chondral lesions of Outerbridge grade ≥2, and medial cuff failure were correlated with poorer SSV scores at 2 years (P≤ .047). Patients with traumatic retears had better CS and OSS scores at 2 years (P≤ .039). CONCLUSION Although arthroscopic revision RCR improved shoulder function, retears were frequent but usually smaller. Patients with retears, however, did not necessarily have poorer shoulder function. Patient satisfaction at 2 years was lower when primary open RCR was performed, when a subscapularis tear or osteoarthritis was present, and when the rotator cuff retear was located at the musculotendinous junction. Patients with traumatic retears showed better functional improvement after revision.
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Affiliation(s)
- Michael Hackl
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
| | - Matthias Flury
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
| | - Christoph Kolling
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
| | - Wolfgang Nebelung
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
| | - Christine A Krauss
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
| | - Nils A Kraemer
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
| | - Philipp R Heuberer
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
| | - Brenda Laky
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
| | - Mathias Wellmann
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
| | | | - Andreas B Imhoff
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
| | - Sven Reuter
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
| | - Georg Anderle
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
| | | | - Eduard Buess
- Investigation performed at Shouldercare, Engeriedspital, Bern, Switzerland
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Lappen S, Siebenlist S, Kadantsev P, Hinz M, Seilern Und Aspang J, Lutz PM, Imhoff AB, Geyer S. Distal biceps tendon ruptures occur with the almost extended elbow and supinated forearm - an online video analytic study. BMC Musculoskelet Disord 2022; 23:599. [PMID: 35733124 PMCID: PMC9214967 DOI: 10.1186/s12891-022-05546-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 06/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Distal biceps tendon ruptures can lead to significant restrictions in affected patients. The mechanisms of injury described in scientific literature are based exclusively on case reports and theoretical models. This study aimed to determine the position of the upper extremities and forces involved in tendon rupture through analyzing video recordings. Methods The public YouTube.com database was queried for videos capturing a clear view of a distal biceps tendon rupture. Two orthopedic surgeons independently assessed the videos for the activity that led to the rupture, the arm position at the time of injury and the forces imposed on the elbow joint. Results Fifty-six video segments of a distal biceps rupture were included (55 male). In 96.4%, the distal biceps tendon ruptured with the forearm supinated and the elbow isometrically extended (non-dynamic muscle engagement) (71.4%) or slightly flexed (24%). The most common shoulder positions were adduction (85.7%) and neutral position with respect to rotation (92.9%). Most frequently a tensile force was enacted on the elbow (92.9%) and the most common activity observed was deadlifting (71.4%). Conclusion Distal biceps tendon ruptures were most commonly observed in weightlifting with a slightly flexed or isometrically extended elbow and forearm supination. These observations may provide useful information for sports specific evidence-based injury prevention, particularly in high performing athletes and individuals engaged in resistance training. Level of evidence Observational study.
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Affiliation(s)
- Sebastian Lappen
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Pavel Kadantsev
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Maximilian Hinz
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | | | - Patricia M Lutz
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Stephanie Geyer
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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Scheiderer B, Obmann S, Feucht MJ, Siebenlist S, Degenhardt H, Imhoff AB, Rupp MC, Pogorzelski J. The Morphology of the Acromioclavicular Joint Does Not Influence the Postoperative Outcome Following Acute Stabilization—A Case Series of 81 Patients. Arthrosc Sports Med Rehabil 2022; 4:e835-e842. [PMID: 35747655 PMCID: PMC9210376 DOI: 10.1016/j.asmr.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/07/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To specifically evaluate the influence of the acromioclavicular (AC)-joint morphology on the outcome after arthroscopically assisted coracoclavicular (CC) stabilization surgery with suspensory fixation systems and to investigate whether an additional open AC-joint reduction and AC cerclage improves the clinical outcome for patients with certain morphologic AC-joint subtypes. Methods Patients with an acute acromioclavicular joint injury, who underwent arthroscopically assisted CC stabilization with suspensory fixation systems with or without concomitant AC cerclage between January 2009 and June 2017 were identified and included in this retrospective cohort analysis. AC-joint morphology was assessed on preoperative radiographs and categorized as “flat” or “non-flat” (“oblique”/“curved”) subtypes. After a minimum of 2 years of follow-up, postoperative Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES), and visual analog scale (VAS) scores for pain were collected. A subgroup analysis of clinical outcomes depending on the surgical technique and morphological subtype of the AC joint was performed. Results Eighty-one patients (95% male, mean age 35 ± 12 years) could be included at a mean follow-up of 57 ± 14 months. Radiographic assessment of AC-joint morphology showed 24 (30%) cases of flat type, 38 (47%) cases of curved type, and 19 (23%) cases of oblique morphology. Postoperatively, no clinically significant difference could be detected after the treatment of AC joint injury via CC stabilization with or without concomitant AC cerclage (VASrest: P = .067; VASmax: P = .144, ASES: P = .548; SANE: P = .045). No clinically significant differences were found between the surgical techniques for the flat morphologic subtype (VASrest: P = .820; VASmax: P = .251; SANE: P = .104; ASES: P = .343) or the non-flat subtype (VASres: P = .021; VASmax: P = .488; SANE: P = .243, ASES: P = .843). Conclusions In arthroscopically assisted AC stabilization surgery with suspensory fixation systems for acute AC-joint injury, the AC-joint morphology did not influence the postoperative outcome, independent of the surgical technique. No clinical benefit of performing an additional horizontal stabilization could be detected in our collective at mid-term follow-up. Level of Evidence Level IV, therapeutic case series.
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Berthold DP, Muench LN, Imhoff AB, Lacheta L. Stabilisierung des Akromioklavikulargelenks. Arthroskopie 2022. [DOI: 10.1007/s00142-022-00546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rupp MC, Mehl J, Feucht MJ, Imhoff AB. Biomechanical Rationale of Correction Osteotomy and Overcorrection. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rupp MC, Muench LN, Ehmann YJ, Themessl A, Winkler PW, Mehl J, Imhoff AB, Feucht MJ. Improved Clinical Outcome and High Rate of Return to Low-Impact Sport and Work After Knee Double Level Osteotomy for Bifocal Varus Malalignment. Arthroscopy 2022; 38:1944-1953. [PMID: 34920011 DOI: 10.1016/j.arthro.2021.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate return to sport (RTS) and work (RTW), as well as clinical outcomes following double level osteotomy (DLO) via combined medial open wedge high tibial osteotomy and lateral closing wedge distal femoral osteotomy for bifocal symptomatic varus malalignment, and to compare these outcome parameters between patients undergoing a single surgery and those undergoing a two-stage procedure. METHODS Consecutive patients who underwent DLO for symptomatic varus malalignment between 12/2007 and 03/2018 were enrolled. Patients converted to arthroplasty (n = 3) during follow-up were excluded. Outcome measures included the International Knee Documentation Committee (IKDC) Score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm score, Tegner Activity Scale, and visual analog scale (VAS) for pain, which were collected preoperatively and at a minimum of 24 months postoperatively. RTS and RTW were evaluated by questionnaire. Outcome measures were compared between DLO performed in a single- versus a two-stage surgery. RESULTS Thirty-two patients (mean age: 44.2 ± 12.6 years), who underwent DLO for varus malalignment (10.1° ± 2.9°) were included at a mean follow-up of 56.9 ± 35.3 months (range: 24-148). Compared to preoperatively, these patients significantly improved in IKDC (50.4 ± 13.9 to 66.1 ± 15.4; P < .001), WOMAC (29.7 ± 19.2 to 11.8 ± 13.5; P < .001) and Lysholm (53.6 ± 23.6 to 73.1 ± 23.6; P = .002) scores at final follow-up. For the WOMAC score, 78% of the patients included reached the minimally important clinical difference, along with a significant reduction of the VAS for pain (5.0 ± 3.0 to 2.5 ± 2.4; P < .001). Postoperatively, 96% of patients returned to sport after 7.7 ± 4.8 months, but at a lower frequency (P = .010) and to fewer disciplines (P = .005) with a shift to low-impact sports. 90% of the patients returned to work at a mean 5.9 ± 9.4 months, with 79% reporting a similar or superior working ability. Patients undergoing a two-stage procedure recovered to full physical working ability at a significantly longer duration, as compared to a single-stage procedure (9.8 ± 3.8 vs 9.0 ± 13.1 months; P = .047). CONCLUSION The majority of patients undergoing DLO for symptomatic varus malalignment, who were not converted to arthroplasty, experienced clinically significant functional improvement at mid-term follow-up. Return to sport and work rates in these patients were high; however, a shift to lower-impact sports disciplines was observed. Similar clinical outcomes can be expected when performing DLO in a single surgery or a two-stage procedure. LEVEL OF EVIDENCE Retrospective case series; Level IV.
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Affiliation(s)
- Marco-Christopher Rupp
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany, School of Medicine
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany, School of Medicine
| | - Yannick J Ehmann
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany, School of Medicine
| | - Alexander Themessl
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany, School of Medicine; Alps Surgery Institute, Annecy, France
| | - Philipp W Winkler
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany, School of Medicine
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany, School of Medicine
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany, School of Medicine.
| | - Matthias J Feucht
- Orthopaedic Clinic Paulinenhilfe, Diakonie-Hospital, Stuttgart, Germany; Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Muench LN, Imhoff AB, Mehl JT. Editorial Commentary: Double-Sling Transfer of Both the Conjoined Tendons and Long Head Biceps Tendon for Glenoid Bone Loss in Patients With Shoulder Instability Shows Biomechanical Benefit in Shoulder Abduction and External Rotation But May Be Insufficient in Mid-Range Arm Positions. Arthroscopy 2022; 38:1441-1443. [PMID: 35501011 DOI: 10.1016/j.arthro.2021.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 02/02/2023]
Abstract
Recurrence of shoulder glenohumeral instability is exacerbated in cases of glenoid bone loss. Surgical bone transfer techniques well address the issue. Innovative soft-tissue tendon transfers may fill the defect plus provide a sling effect. Double-sling transfer of both the conjoined tendons and long head biceps tendon for glenoid bone loss in patients with shoulder instability shows biomechanical benefit in shoulder abduction and external rotation. However, as the sling effect is less pronounced in mid-range arm position, the benefit of double-sling transfer may be insufficient. Moreover, the biomechanical models are limited relative to the complexity of clinical glenohumeral function, and obviously limited to time-zero analysis. We should be careful before we abandon bony augmentation procedures.
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Muench LN, Berthold DP, Otto A, Dyrna F, Bell R, Obopilwe E, Cote MP, Imhoff AB, Mazzocca AD, Beitzel K. Increased Glenohumeral Joint Loads Due to a Supraspinatus Tear Can Be Reversed With Rotator Cuff Repair: A Biomechanical Investigation. Arthroscopy 2022; 38:1422-1432. [PMID: 34801659 DOI: 10.1016/j.arthro.2021.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of an isolated full-thickness supraspinatus (SSP) tear on glenohumeral kinematics and contact mechanics, as well as to quantify improvement following rotator cuff repair (RCR). METHODS Ten fresh-frozen cadaveric shoulders (mean age: 63.1 ± 4.6 years) were tested using a dynamic shoulder simulator. A pressure-mapping sensor was placed between the humeral head and the glenoid. Each specimen underwent the following three conditions: 1) native, 2) isolated full-thickness SSP tear, and 3) RCR. Maximum abduction angle (MAA) and superior humeral head migration (SHM) were measured using 3D motion tracking software. Cumulative deltoid force (CDF) and glenohumeral contact mechanics, including contact area (GCA) and contact pressure (GCP), were assessed at the resting position, as well as at 15°, 30°, 45°, and 60° of glenohumeral abduction. RESULTS Compared to native, the SSP tear resulted in a significant decrease in MAA (Δ-8.3°; P < .001) along with a SHM of 6.4 ± 3.8 mm, while significantly increasing CDF (Δ20.5 N; P = .008), GCP (Δ63.1 kPa; P < .001), and peak GCP (Δ278.6 kPa; P < .001), as well as decreasing GCA (Δ-45.8 mm2; P < .001) at each degree of abduction. RCR reduced SHM to 1.2 ± 2.5 mm, while restoring native MAA, CDF (Δ1.8 N), GCA (Δ4.5 mm2), GCP (Δ-4.5 kPa) and peak GCP (Δ19.9 kPa) at each degree of abduction (P > .999, respectively). CONCLUSION In a dynamic biomechanical cadaveric model, increased glenohumeral joint loads due to a full-thickness SSP tear can be reversed with RCR. More specifically, RCR restored native glenohumeral contact area and contact pressure, while preventing superior humeral head migration and decreasing compensatory deltoid forces. CLINICAL RELEVANCE These time 0 observations indicate that undergoing rotator cuff repair may prevent the development of degenerative changes by significantly reducing glenohumeral joint loads and ensuring sufficiently stable joint kinematics.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A..
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Alexander Otto
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University of Augsburg, Augsburg, Germany
| | - Felix Dyrna
- Department of Trauma, Hand and Reconstructive Surgery, University of Münster, Münster, Germany
| | - Ryan Bell
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany; Department of Shoulder Surgery, ATOS Clinic, Cologne, Germany
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Degenhardt H, Pogorzelski J, Themessl A, Muench LN, Wechselberger J, Woertler K, Siebenlist S, Imhoff AB, Scheiderer B. Reliable Clinical and Sonographic Outcomes of Subpectoral Biceps Tenodesis Using an All-Suture Anchor Onlay Technique. Arthroscopy 2022; 38:729-734. [PMID: 34508820 DOI: 10.1016/j.arthro.2021.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/14/2021] [Accepted: 08/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcomes and structural integrity of primary subpectoral biceps tenodesis using an all-suture anchor onlay technique for long head of the biceps (LHB) tendon pathology. METHODS We conducted a retrospective case series with prospectively collected data of patients who underwent primary, isolated subpectoral biceps tenodesis with a single all-suture anchor onlay fixation between March 2017 and March 2019. Outcomes were recorded at a minimum follow-up of 12 months based on assessments of the American Shoulder and Elbow Surgeons (ASES) score, LHB score, and elbow flexion strength and supination strength measurements. The integrity of the tenodesis construct was evaluated using ultrasound. RESULTS Thirty-four patients were available for clinical and ultrasound examination at a mean follow-up of 18 ± 5 months. The mean ASES score significantly improved from 51.0 ± 14.2 points preoperatively to 89.8 ± 10.5 points postoperatively (P < .001). The minimal clinically important difference for the ASES score was 8.7 points, which was exceeded by 31 patients (91.2%). The mean postoperative LHB score was 92.2 ± 8.3 points. Regarding subcategories, an average of 47.2 ± 6.3 points was reached for "pain/cramps"; 26.4 ± 6.1 points, "cosmesis"; and 18.6 ± 2.6 points, "elbow flexion strength." Both elbow flexion strength and supination strength were similar compared with the nonoperated side (P = .169 and P = .210, respectively). In 32 patients, ultrasound examination showed an intact tenodesis construct, whereas 2 patients (5.9%) sustained failure of the all-suture anchor fixation requiring revision. CONCLUSIONS Primary subpectoral biceps tenodesis using an all-suture anchor onlay technique for pathology of the LHB tendon provides reliable clinical results and a relatively low failure rate (5.9%). LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Hannes Degenhardt
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Themessl
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | - Klaus Woertler
- Department of Radiology, Technical University of Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
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Imhoff AB. [Replacement, transfer or allograft surgery for massive rotator cuff tears]. Oper Orthop Traumatol 2022; 34:2-3. [PMID: 35138434 DOI: 10.1007/s00064-021-00761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Andreas B Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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Geyer S, Winden F, Braunsperger A, Kreuzpointner F, Kleim BD, Lappen S, Imhoff AB, Mehl J, Hinz M. Midterm outcome and strength assessment after quadriceps tendon refixation with suture anchors. Eur J Orthop Surg Traumatol 2022; 33:869-875. [PMID: 35137251 PMCID: PMC10125935 DOI: 10.1007/s00590-022-03218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Quadriceps tendon ruptures (QTR) occur predominantly in middle-aged patients through violent eccentric contraction that occurs either when trying to regain balance or during a fall on the hyperflexed knee. The aim of this study was to quantify midterm postoperative results, including strength potential measured via standardized strength tests following acute (< six weeks) quadriceps tendon refixation using suture anchors. METHODS All consecutive patients with QTR who underwent surgical suture anchor refixation between 2012 and 2019 at a single institution with a minimum follow-up of 12 months were retrospectively evaluated. Outcome measures included Tegner Activity Scale (TAS), Lysholm score, International Knee Documentation Committee subjective knee form (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, return to work rates, and Visual Analog Scale (VAS) for pain. Additionally, a standardized clinical examination and an isometric strength assessment of knee extension and flexion were performed. RESULTS A total of 17 patients (median age 61.0 [25-75% IQR 50.5-72.5]) were available for final assessment at a mean follow-up of 47.1 ± SD 25.4 months. The majority of patients were male (82.4%) and most injuries occurred due to a fall on the hyperflexed knee (76.5%). The average time interval between trauma and surgery was 12.7 ± 7.5 days. Patients achieved a moderate level of activity postoperatively with a median TAS of 4 (3-5.5) and reported good to excellent outcome scores (Lysholm score: 97 (86.5-100); IKDC: 80.7 ± 13.5; KOOS subscales: pain 97.2 (93.1-100), symptoms 92.9 (82.5-100), activities of daily living 97.1 (93.4-100), sport and recreation function 80 (40-97.5) and knee-related quality of life 87.5 (62.5-100). All patients were able to fully return to work and reported little pain [VAS: 0 (0-0)]. No postoperative complications were reported. Strength measurements revealed a significant deficit of knee extension strength in comparison to the contralateral side (p = 0.011). CONCLUSION Suture anchor refixation of acute QTR leads to good functional results and high patient satisfaction without major complications. Isometric knee extension strength, however, may not be fully restored compared to the unaffected side.
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Affiliation(s)
- Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Felix Winden
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexander Braunsperger
- Prevention Center, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Florian Kreuzpointner
- Prevention Center, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Benjamin D Kleim
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sebastian Lappen
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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Hinz M, Kleim BD, Berthold DP, Geyer S, Lambert C, Imhoff AB, Mehl J. Injury Patterns, Risk Factors, and Return to Sport in Brazilian Jiu Jitsu: A Cross-sectional Survey of 1140 Athletes. Orthop J Sports Med 2022; 9:23259671211062568. [PMID: 34988235 PMCID: PMC8721390 DOI: 10.1177/23259671211062568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background Brazilian jiu jitsu (BJJ) is a growing martial art that focuses on grappling techniques. Purpose To quantify the 3-year incidence of BJJ-related injuries and detect common injury patterns as well as risk factors among those practicing BJJ. It was hypothesized that there would be a high incidence of injuries, they would be caused by submissions in sparring situations, and they would occur predominantly at the extremities. Study Design Descriptive epidemiology study. Methods Active BJJ athletes were invited to take an English-language online survey developed by orthopaedic surgeons together with BJJ athletes and a sports scientist. Data were recorded regarding athlete demographics, sporting activity level, injuries within the past 3 years that caused at least a 2-week time loss, injury mechanisms, and return to sport. Results Overall, 1140 responses were received from 62 different countries; 88.9% of all athletes were male, and 63.9% were regular competitors. Within the investigated cohort, 1052 injuries were recorded in 784 athletes, for an injury incidence of 308 per 1000 athletes per year. The lower extremity (45.7%) and upper extremity (30.2%) were predominant sites of injury, with injuries to the knee (27.1%) being the most common. The most frequent knee injuries were meniscal injuries (n = 65), anterior cruciate ligament (ACL) tears (n = 36), and medial collateral ligament injuries (n = 36). ACL tears were especially associated with long time frames for return to sport. Most injuries occurred during sparring (77.6%) and were caused by submissions (29.7%) and takedowns (26.4%). Competing regularly (P = .003), older age (P < .001), and higher belt rank (P = .003) were significant risk factors for injury. Conclusion Injury incidence was high among BJJ athletes surveyed, with 2 out of 3 athletes reporting at least 1 injury within a 3-year period that caused a 2-week absence from training. Most injuries occurred during sparring, and we believe that a high potential for injury reduction lies in drawing awareness to common injury patterns and sites in athletes.
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Affiliation(s)
- Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benjamin D Kleim
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christophe Lambert
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Muench LN, Otto A, Kia C, Obopilwe E, Cote MP, Imhoff AB, Beitzel K, Mazzocca AD, Mehl J. Rotational range of motion of elliptical and spherical heads in shoulder arthroplasty: a dynamic biomechanical evaluation. Arch Orthop Trauma Surg 2022; 142:67-76. [PMID: 32865631 PMCID: PMC8732933 DOI: 10.1007/s00402-020-03587-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/16/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Elliptical shape humeral head prostheses have been proposed to reflect a more anatomic shoulder replacement. Its effect on the rotational range of motion (ROM) compared to a standard spherical head is still not understood. The purpose was to investigate if there would be a difference in rotational ROM when comparing elliptical and spherical prosthetic heads in a dynamic shoulder model. The authors hypothesized that the use of elliptical heads would result in significantly more rotational ROM compared to the spherical head design. MATERIALS AND METHODS Six fresh-frozen, cadaveric shoulders were evaluated using a dynamic shoulder model. After being tested in the native condition, each specimen underwent 6 conditions in the hemiarthroplasty state: (1) matched-fit spherical head, (2) oversized spherical head, (3) undersized spherical head, (4) matched-fit elliptical head, (5) oversized elliptical head, and (6) undersized elliptical head. Following conversion to total shoulder arthroplasty (TSA), the 6 prior conditions were rerun. Each condition was tested at 0°, 30° and 60° of glenohumeral abduction. Rotational ROM was quantified using 3-dimensional tracking, while dynamically applying alternating forces for internal and external rotation via the rotator cuff tendons. RESULTS Elliptical and spherical prosthetic heads showed no significant difference in the degree of the total, internal, and external rotational ROM for both the hemiarthroplasty and TSA state. Conversion from hemiarthroplasty to TSA resulted in less degree of total rotational ROM for both head designs in all abduction positions, without reaching statistical significance. There was a significant decrease in total, internal, and external rotational ROM for both elliptical and spherical heads in every replacement condition, when comparing 0° to 30° and 60° of abduction (P < 0.05, respectively). CONCLUSION In a dynamic shoulder model, elliptical and spherical prosthetic head designs showed no significant difference in the degree of the total, internal, and external rotational ROM in both the hemiarthroplasty and TSA state. LEVEL OF EVIDENCE Controlled laboratory study.
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Affiliation(s)
- Lukas N. Muench
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Otto
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany ,Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Mark P. Cote
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany ,Department of Shoulder Surgery, ATOS Clinic, Cologne, Germany
| | | | - Julian Mehl
- Department of Orthopaedic Surgery, UConn Health, Farmington, CT USA ,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
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Giesler P, Baumann FA, Weidlich D, Karampinos DC, Jung M, Holwein C, Schneider J, Gersing AS, Imhoff AB, Bamberg F, Jungmann PM. Patellar instability MRI measurements are associated with knee joint degeneration after reconstruction of the medial patellofemoral ligament. Skeletal Radiol 2022; 51:535-547. [PMID: 34218322 PMCID: PMC8763754 DOI: 10.1007/s00256-021-03832-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To qualitatively and quantitatively evaluate the 2-year magnetic resonance imaging (MRI) outcome after MPFL reconstruction at the knee and to assess MRI-based risk factors that predispose for inferior clinical and imaging outcomes. MATERIALS AND METHODS A total of 31 patients with MPFL reconstruction were included (22 ± 6 years, 10 female). MRI was performed preoperatively in 21/31 patients. Two-year follow-up MRI included quantitative cartilage T2 and T1rho relaxation time measurements at the ipsilateral and contralateral knee. T2relative was calculated as T2patellofemoral/T2femorotibial. Morphological evaluation was conducted via WORMS scores. Patellar instability parameters and clinical scores were obtained. Statistical analyses included descriptive statistics, t-tests, multivariate regression models, and correlation analyses. RESULTS Two years after MPFL reconstruction, all patellae were clinically stable. Mean total WORMS scores improved significantly from baseline to follow-up (mean difference ± SEM, - 4.0 ± 1.3; P = 0.005). As compared to patients with no worsening of WORMS subscores over time (n = 5), patients with worsening of any WORMS subscore (n = 16) had lower trochlear depth, lower facetal ratio, higher tibial-tuberosity to trochlear groove (TTTG) distance, and higher postoperative lateral patellar tilt (P < 0.05). T2relative was higher at the ipsilateral knee (P = 0.010). T2relative was associated with preoperatively higher patellar tilt (P = 0.021) and higher TTTG distance (P = 0.034). TTTG distance, global T2 values, and WORMS progression correlated with clinical outcomes (P < 0.05). CONCLUSION MPFL reconstruction is an optimal treatment strategy to restore patellar stability. Still, progressive knee joint degeneration and patellofemoral cartilage matrix degeneration may be observed, with patellar instability MRI parameters representing particular risk factors.
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Affiliation(s)
- Paula Giesler
- Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Frederic A. Baumann
- Clinical and Interventional Angiology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Christian Holwein
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Julia Schneider
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Alexandra S. Gersing
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
- Department of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - Pia M. Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
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Hinz M, Geyer S, Winden F, Braunsperger A, Kreuzpointner F, Kleim BD, Imhoff AB, Mehl J. Midterm outcome and strength assessment after proximal rectus femoris refixation in athletes. Arch Orthop Trauma Surg 2022; 142:2263-2270. [PMID: 34664130 PMCID: PMC8522542 DOI: 10.1007/s00402-021-04189-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Proximal rectus femoris avulsions (PRFA) are relatively rare injuries that occur predominantly among young soccer players. The aim of this study was to evaluate midterm postoperative results including strength potential via standardized strength measurements after proximal rectus femoris tendon refixation. It was hypothesized that the majority of competitive athletes return to competition (RTC) after refixation of the rectus femoris tendon without significant strength or functional deficits compared to the contralateral side. METHODS Patients with an acute (< 6 weeks) PRFA who underwent surgical refixation between 2012 and 2019 with a minimum follow-up of 12 months were evaluated. The outcome measures compiled were the median Tegner Activity Scale (TAS) and mean RTC time frames, Harris Hip Score (HHS), Hip and Groin Outcome Score (HAGOS) subscales, International Hip Outcome Tool-33 (iHOT-33), and Visual Analog Scale (VAS) for pain. In addition, a standardized isometric strength assessment of knee flexion, knee extension, and hip flexion was performed to evaluate the functional result of the injured limb in comparison to the uninjured side. RESULTS Out of 20 patients, 16 (80%) patients were available for final assessment at a mean follow-up of 44.8 ± SD 28.9 months. All patients were male with 87.5% sustaining injuries while playing soccer. The average time interval between trauma and surgery was 18.4 ± 8.5 days. RTC was possible for 14 out of 15 previously competitive athletes (93.3%) at a mean 10.5 ± 3.4 months after trauma. Patients achieved a high level of activity postoperatively with a median (interquartile range) TAS of 9 (7-9) and reported good to excellent outcome scores (HHS: 100 (96-100); HAGOS: symptoms 94.6 (89.3-100), pain 97.5 (92.5-100), function in daily living 100 (95-100), function in sport and recreation 98.4 (87.5-100), participation in physical activities 100 (87.5-100), quality of life 83.1 ± 15.6; iHot-33: 95.1 (81.6-99.8)). No postoperative complications were reported. Range of motion, isometric knee flexion and extension, as well as hip flexion strength levels were not statistically different between the affected and contralateral legs. The majority of patients were "very satisfied" (56.3%) or "satisfied" (37.5%) with the postoperative result and reported little pain (VAS 0 (0-0.5)). CONCLUSION Surgical treatment of acute PRFA yields excellent postoperative results in a young and highly active cohort. Hip flexion and knee extension strength was restored fully without major surgical complications. LEVEL OF EVIDENCE Retrospective cohort study; III.
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Affiliation(s)
- Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Stephanie Geyer
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Felix Winden
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexander Braunsperger
- Prevention Center, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Florian Kreuzpointner
- Prevention Center, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Benjamin D Kleim
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
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Rupp MC, Kadantsev PM, Siebenlist S, Hinz M, Feucht MJ, Pogorzelski J, Scheiderer B, Imhoff AB, Muench LN, Berthold DP. Low rate of substantial loss of reduction immediately after hardware removal following acromioclavicular joint stabilization using a suspensory fixation system. Knee Surg Sports Traumatol Arthrosc 2022; 30:3842-3850. [PMID: 35451639 PMCID: PMC9568474 DOI: 10.1007/s00167-022-06978-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To evaluate immediate loss of reduction in patients undergoing hardware removal after arthroscopically assisted acromioclavicular (AC) joint stabilization using a high-tensile suture tape suspensory fixation system and to identify risk factors associated with immediate loss of reduction. MATERIALS AND METHODS Twenty-two consecutive patients with a mean age of 36.4 ± 12.6 years (19-56), who underwent hardware removal 18.2 ± 15.0 months following arthroscopically assisted stabilization surgery using a suspensory fixation system for AC joint injury between 01/2012 and 01/2021 were enrolled in this retrospective monocentric study. The coracoclavicular distance (CCD) as well as the clavicular dislocation/acromial thickness (D/A) ratio were measured on anterior-posterior radiographs prior to hardware removal and immediately postoperatively by two independent raters. Loss of reduction, defined as 10% increase in the CCD, was deemed substantial if the CCD increased 6 mm compared to preoperatively. Constitutional and surgical characteristics were assessed in a subgroup analysis to detect risk factors associated with loss of reduction. RESULTS Postoperatively, the CCD significantly increased from 12.6 ± 3.7 mm (4.8-19.0) to 14.5 ± 3.3 mm (8.7-20.6 mm) (p < 0.001) while the D/A ratio increased from 0.4 ± 0.3 (- 0.4-0.9) to 0.6 ± 0.3 (1.1-0.1) (p = 0.034) compared to preoperatively. In 10 cases (45%), loss of reduction was identified, while a substantial loss of reduction (> 6 mm) was only observed in one patient (4.5%). A shorter time interval between index stabilization surgery and hardware removal significantly corresponded to immediate loss of reduction (11.0 ± 5.6 vs. 30.0 ± 20.8 months; p = 0.007), as hardware removal within one year following index stabilization was significantly associated with immediate loss of reduction (p = 0.027; relative risk 3.4; odds ratio 11.67). CONCLUSIONS Substantial loss of reduction after hardware removal of a high-tensile suture tape suspensory fixation system was rare, indicating that the postoperative result of AC stabilization is not categorically at risk when performing this procedure. Even though radiological assessment of the patients showed a statistically significant immediate superior clavicular displacement after this rarely required procedure, with an increased incidence in the first year following stabilization, this may not negatively influence the results of ACJ stabilization in a clinically relevant way. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marco-Christopher Rupp
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Pavel M. Kadantsev
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russian Federation ,grid.77642.300000 0004 0645 517XPeoples Friendship University of Russia, Moscow, Russian Federation
| | - Sebastian Siebenlist
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Maximilian Hinz
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Matthias J. Feucht
- Orthopaedic Clinic Paulinenhilfe, Diakonie-Hospital, Stuttgart, Germany ,grid.5963.9Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Jonas Pogorzelski
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Bastian Scheiderer
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lukas N. Muench
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Daniel P. Berthold
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
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Mehl J, Feucht M, Achtnich A, Imhoff AB, Niemeyer P, Angele P, Zinser W, Spahn G, Loer I, Kniffler H, Schauf G, Schmitt A. Autologous chondrocyte implantation combined with anterior cruciate ligament reconstruction: similar short-term results in comparison with isolated cartilage repair in ligament intact joints. Knee Surg Sports Traumatol Arthrosc 2022; 30:3249-3257. [PMID: 34626229 PMCID: PMC9464143 DOI: 10.1007/s00167-021-06764-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Both acute ruptures of the anterior cruciate ligament (ACL) as well as chronic ACL insufficiency show a high association with focal cartilage defects of the knee. However, the results after combined ACL reconstruction and cartilage repair are not well investigated. The aim of the present study was to investigate the short-term outcomes after autologous chondrocyte implantation (ACI) in combination with ACL reconstruction and to compare the results with patients who underwent isolated ACI in ligament intact knees. METHODS All patients who were registered in the German Cartilage Registry with ACI for focal cartilage defects in the knee joint in combination with ACL reconstruction and who completed the 24 month follow-up were included in the study group. A matched-pair procedure according to gender, defect location, defect size, and age was used to create a control group of patients with isolated ACI in ACL intact joints. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the numeric analog scale for pain (NAS) were used to assess the preoperative state as well as the clinical outcomes 12 and 24 months after surgery. RESULTS A total of 34 patients were included in both the study group (age mean 33.3 ± SD 8.8 years) and the control group (33.6 ± 8.4 years) with a median defect size of 466 (25%-75% IQR 375-600) mm2 and 425 (IQR 375-600) mm2, respectively. In comparison with the preoperative state (median 67, IQR 52-75), the study group showed a significant increase of the total KOOS after 12 months (78, IQR 70-86; p = 0.014) and after 24 months (81, IQR 70-84; p = 0.001). The NAS for pain did not change significantly in the postoperative course. In comparison with the control group there was no significant difference for the total KOOS neither preoperative (control group median 67, IQR 52-73) nor at any postoperative time point (12 months: 82, IQR 67-93; 24 months: 81, IQR 71-91). CONCLUSION The clinical short-term outcomes after ACI at the knee joint in combination with ACL reconstruction are good and similar to the results after isolated ACI in ligament intact knees. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Matthias Feucht
- Department of Orthopaedic Surgery, Paulinenhilfe, Diakonieklinikum, Stuttgart, Germany
| | - Andrea Achtnich
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University, Ismaninger Strasse 22, 81675 Munich, Germany
| | | | - Peter Angele
- grid.411941.80000 0000 9194 7179Department for Traumatology, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Zinser
- Department of Orthopaedic Surgery and Traumatology, St. Vinzenz Hospital, Dinslaken, Germany
| | - Gunter Spahn
- grid.275559.90000 0000 8517 6224Center of Trauma and Orthopaedic Surgery Eisenach, Jena University Hospital, Eisenach, Germany
| | - Ingo Loer
- Orthopaedie in Essen, Essen, Germany
| | | | | | - Andreas Schmitt
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University, Ismaninger Strasse 22, 81675 Munich, Germany
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Rupp MC, Degenhardt H, Winkler PW, Hinz M, Ehmann YJ, Imhoff AB, Pogorzelski J, Themessl A. High return to sports and return to work rates after anatomic lateral ankle ligament reconstruction with tendon autograft for isolated chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc 2022; 30:3862-3870. [PMID: 35357531 PMCID: PMC9568480 DOI: 10.1007/s00167-022-06937-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate clinical outcomes as well as return to sports (RTS) and return to work (RTW) rates following anatomic lateral ankle ligament reconstruction with a tendon autograft for chronic lateral ankle instability (CLAI) in a high-risk population, and to compare these outcome parameters between patients having received a gracilis tendon autograft (GT) and free split peroneus brevis tendon (PBT) autograft. METHODS Twenty-eight consecutive patients, who were diagnosed with CLAI, presenting with ≥ 1 risk factor (ligamentous hyperlaxity, insufficient substance of native ligament and/or high-demand athlete), who underwent ankle ligament reconstruction with a tendon autograft between January 2011 and December 2018, were included in this retrospective study. At 63.7 ± 28.0 months (24-112), 23 patients with a mean age of 29.7 ± 10.9 years were available for follow-up. The Karlsson Score, the Foot and Ankle Outcome Score (FAOS), the Tegner Activity Scale and the visual analog scale (VAS) for pain were collected at a minimum follow-up of 24 months. RTS and RTW were evaluated by questionnaire. A subgroup analysis with regard to the graft used for ankle ligament reconstruction (GT versus PBT) was performed. RESULTS Patients reported a Karlsson score of 82.1 ± 17.5 (37-100), a FAOS score of 87.8 ± 8.4 (73-99), a median Tegner activity scale of 5.0 (IQR 4-6) and a VAS for pain of 0.5 ± 0.9 (0-4) at rest and of 2.0 ± 2.1 (0-7) during activities at final follow-up. Postoperatively, 96% of patients had returned to sports after 8.3 ± 6.2 months. All patients (100%) had returned to work at 3.5 ± 5.7 (0-24) months, with 87% reporting an equal or improved working ability compared to that preoperatively. Postoperatively, exercise hours per week were significantly reduced compared to preoperatively in patients with a split PBT (n = 12; 13.0 ± 12.9 to 5.6 ± 6.4 h, p = 0.038) autograft as opposed to patients with a GT autograft (n = 11; 13.1 ± 8.7 to 12.4 ± 7.1 h, n.s.). No other group differences were observed. CONCLUSION Good patient-reported outcomes as well as excellent RTS and RTW rates can be achieved in high-risk patients undergoing ankle ligament reconstruction with a tendon autograft for CLAI. These results may be helpful in preoperatively managing patients' expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marco-Christopher Rupp
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Hannes Degenhardt
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Philipp W. Winkler
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Yannick J. Ehmann
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Alexander Themessl
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,Alps Surgery Institute, Clinique Générale Annecy, 4 Chem. de la Tour la Reine, 74000 Annecy, France
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Imhoff AB, Bartsch E, Becher C, Behrens P, Bode G, Cotic M, Diermeier T, Falk H, Feucht MJ, Haupt U, Hinterwimmer S, Holz J, Hutter R, Kaiser R, Knoblauch T, Nebelung W, Niemeyer P, O’Donnel T, Pagenstert G, Patzer T, Rose T, Rupp MC, Tischer T, Venjakob AJ, Vogt S, Pogorzelski J. The lack of retropatellar resurfacing at index surgery is significantly associated with failure in patients following patellofemoral inlay arthroplasty: a multi-center study of more than 260 patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:1212-1219. [PMID: 33811265 PMCID: PMC9007771 DOI: 10.1007/s00167-021-06544-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 03/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the clinical outcomes of patients with a minimum 2-year follow-up following contemporary patellofemoral inlay arthroplasty (PFIA) and to identify potential risk factors for failure in a multi-center study. METHODS All patients who underwent implantation of PFIA between 09/2009 and 11/2016 at 11 specialized orthopedic referral centers were enrolled in the study and were evaluated retrospectively at a minimum 2-year follow-up. Clinical outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner Scale, the visual analogue scale (VAS) for pain, and subjective patient satisfaction. Pre- and perioperative risk factors were compared among failures and non-failures to determine potential risk factors. RESULTS A total of 263 patients (85% follow-up rate) could be enrolled. The mean age at the time of index surgery was 49 ± 12 years with a mean postoperative follow-up of 45 ± 18 months. The overall failure rate was 11% (28 patients), of which 18% (5 patients) were patients with patella resurfacing at index surgery and 82% (23 patients) were patients without initial patella resurfacing. At final follow-up, 93% of the patients who did not fail were satisfied with the procedure with a mean transformed WOMAC Score of 84.5 ± 14.5 points, a mean KOOS Score of 73.3 ± 17.1 points, a mean Tegner Score of 3.4 ± 1.4 points and a mean VAS pain of 2.4 ± 2.0 points. An increased BMI was significantly correlated with a worse postoperative outcome. Concomitant procedures addressing patellofemoral instability or malalignment, the lack of patellofemoral resurfacing at the index surgery and a high BMI were significantly correlated with failure in our patient cohort. CONCLUSION Patellofemoral inlay arthroplasty shows high patient satisfaction with good functional outcomes at short-term follow-up and thus can be considered a viable treatment option in young patients suffering from isolated patellofemoral arthritis. Patellar resurfacing at index surgery is recommended to decrease the risk of failure. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Andreas B. Imhoff
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Eva Bartsch
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Christoph Becher
- ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115 Heidelberg, Germany
| | - Peter Behrens
- Orthodok, Tonndorfer Hauptstraße 71, 22045 Hamburg, Germany
| | - Gerrit Bode
- Department of Orthopedics, University Hospital of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Matthias Cotic
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Theresa Diermeier
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Holger Falk
- Gelenkzentrum Rhein-Main, Frankfurter Straße 94, 65239 Hochheim am Main, Germany
| | - Matthias J. Feucht
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Ulrich Haupt
- Orthomotion, City Clinic Thun, Marktgasse 17, 3600 Thun, Switzerland
| | | | | | - René Hutter
- Department of Orthopedics, Kantonspital Graubünden, Loëstrasse 99, 7000 Chur, Switzerland
| | - René Kaiser
- Orthocentrum, Hansastr. 1-3, 20149 Hamburg, Germany
| | - Tobias Knoblauch
- Gelenkzentrum Leipzig, Richard-Lehmann-Str. 21, 04275 Leipzig, Germany
| | - Wolfgang Nebelung
- Department of Sport Orthopedics, St. Vinzenz Hospital, Schloßstr. 85, 40477 Düsseldorf, Germany
| | - Philipp Niemeyer
- Department of Orthopedics, University Hospital of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Turlough O’Donnel
- Center for Orthopaedics, Beacon Hospital, Sandyford, Dublin 18, Dublin, Ireland
| | - Geert Pagenstert
- Knee Institute Basel, CLARAHOF Clinic of Orthopaedic Surgery, MERIAN-ISELIN-Hospital, Swiss Olympic Medical Center, Föhrenstr. 2, 4054 Basel, Switzerland
| | - Thilo Patzer
- Orthopädie-Zentrum, Schön Klinik, Am Heerdter Krankenhaus 2, 40549 Düsseldorf, Germany
| | - Tim Rose
- Gelenkzentrum Leipzig, Richard-Lehmann-Str. 21, 04275 Leipzig, Germany
| | - Marco C. Rupp
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Thomas Tischer
- Department of Orthopedics, University Hospital of Rostock, Doberanerstr. 142, 18057 Rostock, Germany
| | - Arne J. Venjakob
- Department of Sport Orthopedics, St. Vinzenz Hospital, Schloßstr. 85, 40477 Düsseldorf, Germany
| | - Stephan Vogt
- Department of Sports Orthopedics, Hessing Stiftung, Hessingstr. 17, 86199 Augsburg, Germany
| | - Jonas Pogorzelski
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
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50
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Berthold DP, Willinger L, LeVasseur MR, Marrero DE, Bell R, Muench LN, Zenon K, Imhoff AB, Herbst E, Cote MP, Arciero RA, Edgar CM. High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury: Response. Am J Sports Med 2022; 50:NP3-NP5. [PMID: 34984957 DOI: 10.1177/03635465211049388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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